Nath Karthik, Reyaldeen Reza, Mack Kathyrn, Sistla Laxmi, Palamuthusingam Dharmenaan, Zahir Syeda Farah, Dave Richa, Muller Juanita, McCann Andrew
Icon Cancer Centre, South Brisbane, Queensland, Australia.
Department of Vascular Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
ANZ J Surg. 2022 Mar;92(3):453-460. doi: 10.1111/ans.17265. Epub 2021 Oct 18.
Acute limb ischaemia (ALI) is a limb and life-threatening condition with significant morbidity. There are currently no consensus recommendations for the investigative practices to determine the aetiology of ALI presenting without a known aetiology. We undertook a detailed analysis of all investigations performed to identify an underlying precipitant in those with unexplained ALI and formulated a suggested diagnostic algorithm for the evaluation of unexplained ALI.
ALI cases presenting to a tertiary referral centre over a 3-year period were reviewed, and known aetiologies, and investigations undertaken to determine the underlying aetiology of unexplained ALI were obtained.
Unexplained ALI was found in 27 of 222 patients (12%), of which 21 (78%) had a cause for ALI established after further investigations. Six patients had no cause identified despite extensive work-up. Most patients with unexplained ALI had a cardioembolic source identified as the underlying cause (62%), and this included atrial fibrillation, infective endocarditis, cardiac myxoma and intra-cardiac thrombus. Other causes of unexplained ALI were detected by computed tomography (CT) imaging and included newly diagnosed significant atherosclerotic disease (19%), embolism from isolated proximal large vessel thrombus (10%) and metastatic malignancy (10%). There were no cases attributed to inherited thrombophilias, myeloproliferative neoplasms or anti-phospholipid syndrome.
Among patients with unexplained ALI, the majority had a cardioembolic source highlighting the importance of comprehensive cardiac investigations. A subset of patients had alternative causes identified on CT imaging. These data support the use of a collaborative and integrative diagnostic algorithm in the evaluation of unexplained ALI.
急性肢体缺血（ALI）是一种威胁肢体和生命的疾病，具有较高的发病率。目前对于确定病因不明的ALI病因的调查方法尚无共识性建议。我们对所有为确定不明原因ALI潜在病因所进行的检查进行了详细分析，并制定了一个评估不明原因ALI的建议诊断算法。
回顾了3年期间在一家三级转诊中心就诊的ALI病例，获取已知病因以及为确定不明原因ALI潜在病因所进行的检查。
222例患者中有27例（12%）为不明原因ALI，其中21例（78%）在进一步检查后确定了ALI的病因。尽管进行了广泛检查，仍有6例未查明病因。大多数不明原因ALI患者被确定潜在病因是心源性栓塞（62%），包括心房颤动、感染性心内膜炎、心脏黏液瘤和心内血栓。通过计算机断层扫描（CT）成像检测到的不明原因ALI的其他病因包括新诊断的严重动脉粥样硬化疾病（19%）、孤立近端大血管血栓形成的栓塞（10%）和转移性恶性肿瘤（10%）。没有病例归因于遗传性血栓形成倾向、骨髓增殖性肿瘤或抗磷脂综合征。
在不明原因ALI患者中，大多数有心脏栓子来源，这突出了全面心脏检查的重要性。一部分患者在CT成像上发现了其他病因。这些数据支持在评估不明原因ALI时使用协作性和综合性诊断算法。
