Ueberrueck T, Marusch F, Schmidt H, Gastinger I
Department of Vascular Surgery Friedrich-Schiller University, Jena, Germany.
J Cardiovasc Surg (Torino). 2007 Apr;48(2):181-6.
Analysis of risk factors for the outcome of arterial embolism of the extremities (EE).
Between 1999 and 2003, all patients (n=200) with an EE diagnosed in various departments of the hospital were recruited and analysed retrospectively (single center study). Exclusion criteria were isolated digital emboli, iatrogenic emboli and arterial thromboses. For statistical analysis was used the multivariate nominal regression.
There were 138 (69%) leg, and 62 (31%) arm, emboli. Preoperative angiography was performed in 88 patients; a total of 119 (59.5%) cases of incomplete ischemia (leg n=69, arm n=50) were seen. The most common cause of the embolism (73%) was atrial fibrillation (AF). One hundred and seventhyt four patients (87%) were treated by primary surgery. The major amputation rate (lower limb) was 4.3%. Additional arterial emboli were seen in 14 (7%). The mortality rate was 13% (upper extremity embolism 4.8%; lower extremity embolism 16.7%; P=0.021). After discharge, 32.2% of the patients received oral anticoagulation, and 37.9% antiplatelet therapy. The statistical analysis identified postoperative cerebral/visceral thromboembolism as independent risk factor for mortality.
The main risk factor for EE is AF. Hospital mortality is determined by comorbidity and cerebral or visceral embolism. For this reason, effective oral anticoagulation is required, but is possible in only one-third of the patients after discharge.
分析肢体动脉栓塞（EE）预后的危险因素。
1999年至2003年期间，招募并回顾性分析了在医院各科室诊断为EE的所有患者（n = 200）（单中心研究）。排除标准为孤立性指（趾）动脉栓塞、医源性栓塞和动脉血栓形成。采用多变量名义回归进行统计分析。
有138例（69%）为腿部栓塞，62例（31%）为手臂栓塞。88例患者术前行血管造影；共发现119例（59.5%）不完全缺血病例（腿部69例，手臂50例）。栓塞的最常见原因（73%）是心房颤动（AF）。174例患者（87%）接受了一期手术治疗。大截肢率（下肢）为4.3%。14例（7%）出现额外的动脉栓塞。死亡率为13%（上肢栓塞4.8%；下肢栓塞16.7%；P = 0.021）。出院后，32.2%的患者接受口服抗凝治疗，37.9%接受抗血小板治疗。统计分析确定术后脑/内脏血栓栓塞是死亡率的独立危险因素。
EE的主要危险因素是AF。医院死亡率由合并症以及脑或内脏栓塞决定。因此，需要有效的口服抗凝治疗，但出院后仅三分之一的患者可行。
