Risk factors analysis of thromboembolectomy for acute thromboembolic lower extremity ischemia in native arteries.

BACKGROUND: Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic lower limb ischemia (ATLI) in native arteries and to create a predictive score for amputation-free survival (AFS) at 30 days. METHODS: It is a single center, retrospective analysis of a four years period. All patients had ThEmb: adjunctive procedures included femoral and/or popliteal endarterectomy in 30 (18.3%) cases, PTA- stent in 24 (14.6%), and femoral endarterectomy plus PTA-stent in 12 (7.3%). Fasciotomies were performed in 6 (3.6%) patients. Predictors of AFS identified on univariate screen (inclusion threshold, P < .20) were included in a multivariable model. The resulting significant predictors were assigned an integer score to stratify patients into risk groups. RESULTS: Authors analyzed 164 limbs in 164 patients. Mean age was 80 ± 10 years (range, 40-99). In-hospital mortality was 9.8% (n = 16); AFS at 30 days was 84.7% (n = 139). The anatomic level (iliac vs. femoro-popliteal vs. infrapopliteal) of the occlusion did not affect AFS (P = .326). Multivariable analysis identified six significant predictors of AFS at 30 days: age >85 (P = 0.050), chronic obstructive pulmonary disease (P = 0.008), chronic renal insufficiency (P = 0.019), late (>6 hours) onset (P = 0.004), the presence of major neurologic deficit (P = 0.023), and an increased (>800IU/L) level of creatin-phospho-kinase (P = 0.001). An integer score generated two risk groups [low-risk 0-2 (70.1% of cohort), and high-risk ≥3 (29.9% of cohort)]: stratification of the patients according to risk category yielded significantly different AFS at 30 days (low-risk 5.2% vs. high- risk 38.8%, P < 0.0001). CONCLUSIONS: Among patients selected to undergo ThEmb for ATLI in native arteries, this risk score identified a group of patients with a 40% chance of death or major amputation at 30 days. The score can help to optimize the operative strategy but further prospective validation is needed.