Acute limb ischemia is a condition that involves a sudden decrease in the arterial blood supply to the extremities. Vascular surgeons find it challenging for treating acute limb ischemia. In several cases, there is a requirement for amputation. Endovascular treatment has emerged as the preferred method over open surgery in context to mortality rate and limb salvage. However, the endovascular treatment also had an increased risk of hemorrhagic complications.

The author of this retrospective consecutive cohort study wrote, “The main objective of this study was to determine the long-term estimates of limb salvage and survival in patients with ALI receiving open surgery vs endovascular revascularization.”

The study includes the patients who underwent endovascular or open surgery treatment between July 2010 to July 2016 at the Vascular and Endovascular Surgery Unit, Hospital do Servidor Público Estadual (São Paulo, Brazil). The researchers analyzed the limb salvage, mortality, and survival rate in both the open surgery and endovascular surgery groups. The analysis was done at 720 days.

69 patients were included in the group out of which 46 patients undergone open surgery while 23 patients undergone endovascular treatment. The rate of chronic kidney disease and arrhythmia was higher in the open surgery group otherwise the clinical characteristics were similar in both groups. Patients in the open surgery group has a higher prevalence of Rutherford IIB acute limb ischemia. The open surgery group had a higher level of creatine kinase before surgery.

Overall survival estimates and limb salvage were found to be similar in both groups. Seven patients died during the first 30 days and out of these, six patients were from the open surgery groups.

The study concludes that both treatments are safe and effective in managing acute limb ischemia. The result of this study combined with the available literature indicates that for Rutherford I and IIA acute limb ischemia, endovascular treatment should be preferred. The vascular surgeon may opt for open surgery in patients with Rutherford IIB and arterial embolism. This may be due urgency to restore blood flow in patients with severe acute limb ischemia.

Source

de Athayde Soares R, Matielo MF, Brochado Neto FC, Cury MVM, Duque de Almeida R, de Jesus Martins M, Pereira de Carvalho BV, Sacilotto R. Analysis of the results of endovascular and open surgical treatment of acute limb ischemia. J Vasc Surg. 2019 Ma