DISSERTATION ABSTRACT
Epidemiology of acute arterial occlusions of the lower limbs at a university hospital: retrospective study of 95 patients
Rafael Pasini del Claro
MSc. in Principles of Surgery, Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil
ABSTRACT
INTRODUCTION: Acute arterial occlusion of the lower limbs presents embolic etiology, in most cases originated in the heart, and thrombotic etiology in patients with peripheral obstructive arterial disease. It is a common clinical condition that is becoming more frequent due to increased age of the population and incidence of atherosclerotic cardiovascular disease. It is manifested by sudden and acute pain, paresthesia, paralysis, reduction in temperature and pallor on affected limb, besides absent or reduced distal pulses at occlusion site. It presents considerable morbidity and mortality rates.
OBJECTIVES: To evaluate epidemiology of acute arterial occlusions of the lower limbs, considering incidence of gender and age, etiologic factors, relation with hypertension, diabetes mellitus, smoking and anatomical location of occlusions. Occlusion time, treatment and fasciotomy were also assessed.
METHODS: This study was performed at the angiology and vascular surgery service of Hospital Universitário Evangélico de Curitiba between January 2000 and April 2005. The medical records of 95 patients with acute arterial occlusion of the lower limbs were reviewed, excluding cases related to trauma.
RESULTS: Of all included patients, 54.7% were male and mean age was 61.9 years. Thrombotic etiology occurred in 49.5% of the patients, embolic etiology in 40% and indeterminate in 10.5%. As to personal history, hypertension was present in 55.8% of the patients, diabetes mellitus in 26.3% and 44.2% reported being smokers. Hypertension, diabetes mellitus and smoking occurred in the same ratio in patients with acute arterial occlusion of embolic and thrombotic etiology. Hypertension, diabetes mellitus and smoking presented greater incidence in these patients when compared with patients with indeterminate etiology. The aortic-iliac territory was affected in 42.1% of the cases, the femoropopliteal territory in 51.6% and the popliteal-tibial territory in 6.3%. Mean occlusion time was 6.8 days. All patients were submitted to thromboembolectomy; other procedures at the same surgical setting were performed in 11 of them (11.6%), as an attempt to revert ischemia and save the limb (one aortobifemoral bypass, one femorodistal bypass, four femorofemoral crossover bypasses, four femoropopliteal proximal bypasses and one lumbar sympathectomy). Fasciotomy was necessary in 8.4% of the patients.
CONCLUSION: Incidence was similar between genders and there was prevalence in patients aged more than 50 years. Embolic and thrombotic etiology occurred in the same proportion, and most patients were hypertensive. In addition, the most frequent anatomical location of the occlusions was the femoropopliteal territory.
Keywords: Arterial occlusion, lower limb, embolism, thrombosis.
Manuscript received February 12, 2007, accepted May 14, 2007.
This dissertation was presented at the Graduate Program in Principles of Surgery, Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Hospital Universitário Evangélico de Curitiba (HUEC), Curitiba, PR, Brazil, to obtain the title of MSc.
Advisor: Prof. Dr. Constantino Miguel Neto
Presentation: 09/12/2005
Examiners: Prof. Dr. Armando de Carvalho Lobato, Prof. Dr. Jorge Henrique Stalke and Prof. Dr. Jurandir Marcondes Ribas Filho
Publication Dates
-
Publication in this collection
20 Sept 2007 -
Date of issue
June 2007
