Lifespan of patients after endured embolism of the aorta and major arteries of the limbs

Melnikov M.V., Sotnikov A.V., Melnikov V.M., Papava G.D.

North-Western State Medical University named after I.I. Mechnikov under the RF Ministry of Public Health, Saint Petersburg, Russia

The authors analysed the remote results of treatment of patients having endured embologenic arterial obstruction. Over the last 47 years, specialists of the Department of Cardiovascular Surgery No1 of the North-Western State Medical University named after I.I. Mechnikov have rendered emergency medical care to a total of 3,455 patients presenting with embolisms of the aorta and arteries of the limbs. The remote results of treatment were followed up in 978 patients within the terms varying from 1 year to 30 years. The cumulative survival of patients at 1 year of follow up amounted to 72±2.9%, at 2 years to 55±3.3%, at 3 years to 46.1±3.3%, at 5 years to 33.5±3.4%, and at 10 years to only 17.8±3.8%. The subanalysis of the remote results of treatment of patients having sustained arterial embolisms was carried out in three groups of patients, depending on the character of the underlying disease. In patients of the 1st group, the development of arterial embolism was caused by atrial fibrillation of non-valvular aetiology, taking course on the background of hypertensive disease, IHD. The cumulative survival of patients of this group at 1 year of follow up amounted to 66.6±4.5%, at 3 years to 37.5±4.8%, at 5 years to 23.1±4.9% and at 10 years to less than 6%. Death was caused by progressing cardiovascular insufficiency in more than 60% of patients, by acute myocardial infarction in nearly 20% of cases and in 10% by impairment of cerebral circulation. In patients of the 2nd group, arterial embolisms were the consequences of endured infarction; their cumulative survival at 1 year of follow up amounted to 70.1±6.5%, at 3 years to 34.5±7.1%, at 5 years to 23.6±6.6%, and at 10 years to 12.5±6.5%. Patients of the 3rd group suffered from acquired heart valve disease of rheumatic aetiology, with the cumulative survival at 1 year amounting to 76.8±5.4%, at 3 years to 56.3±6.4%, at 5 years to 43.3±6.7% and at 10 years to 19.6±6.9%. In the thanatogenesis of more than 60% of patients there were thromboembolic complications, with progressing cardiac insufficiency present in nearly 30% of cases. The pattern of the remote results of treatment of patients with embolisms of the aorta and arteries of the limbs is strongly suggestive of the necessity of working out a comprehensive programme of medical rehabilitation.

KEY WORDS: embolism of the aorta and arteries of limbs, acute limb ischaemia remote results, quality of life, lifespan, survival.

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