Sibiul Medical nr 4_2007.p65

• Hgb, creatinine, preoperative administration of
heparin (≥ 5000 units)
• Duration of symptoms at the start of the operation
(≥ 6 h, 7 – 12 h, 13 – 24 h, ≥ 25h)
• Level of arterial oclusion (aortic, iliac, AFS, AP)
• Duration of the operativie procedure
The postoperative determinants studied included:
• Postoperative heartfailure
• Any reoperation and postoperative heparin (no
treatment ≥ 15.000 units days 1 – 3, ≥ 15.000 units days 4
–) and L.M.H.
RESULTS:
Preoperative risk factors:
Table 1. Preoperative risk factors for amputation after
operative embolectomy for acute arterial oclusion
VARIABLE
DISTRIBUTION
Cases Controls
History of myocardial 9 7
infarction
No 55 60
1 7 4
2 – 4 3 1
Angina pectoris
No 40 42
Yes 25 23
Atrial fibrilation
No 25 36
Yes 40 29
History of heart failure
No 26 10
Yes 39 55
History of cerebrovascular lesion
No 35 47
Yes 30 18
Chronic ischemia
No 45 57
Yes 20 88
Diabetes
No 50 52
Yes 15 13
A history of one myocardial infarction was not
singnificantly associated with a risk for amputation,
whereas a history of two to four myocardial infarction
entailed on increased risk. Atrial fibrilation reduced the
amputation risk by 50 percent, but other cardiac
arrhythmias did not. Anamnestic evidence of heart failure
was associated with a lowered amputation risk.
Tabel 2. Perioperative risk factors for amputation after
operative embolectomy for acute arterial oclusion
VARIABLE DISTRIBUTION
Cases Controls
Acute myocardial infarction (< 30 days)
No 64 63
Yes 1 2
Acute heart failure
No 60 62
Yes 5 3
Recent cerebrovascular lesion (< 30 days)
No 63 64
Yes 2 1
Preoperative heparine
No 5 4
≥5000 u.i. 60 61
Duration of symptoms (h)
≤6 16 24
7 – 12 38 37
13 – 24 10 4
≥25 2 –
Level of oclusion:
Aortic 1 2
Iliac 21 15
Supr. Femural 40 46
Popliteal 13 2
A recent myocardial infarction lowered the risk of
amputation, whereas acute heart failure and recent
cerebrovascular lesion showed no association. The serum
haemoglobin and creatinine levels at time of hospital
admission, analysed as continous variables, did not affect
the amputation risk.
A long duration of symptom carried an increased risk,
singnificantly so above a duration of 25 h compared with
6 h or less. The more distal the oclusion the higher the
risk of amputation. The risk of limb loss within 30 days
was 20 percent lower in patients who received 5000 united
heparin or more during the operation than in those who
did not receive such treatment: the difference in risk
between the groups was not statistically significant.
Postoperative risk factors (Table 3.) for amputation after
operative embolectomy for acute arterial oclusion.
74 „Sibiul Medical“ Volum 19 Nr. 4/2007