Late presentation of acute limb ischemia: causes and outcomes

Objective: To determine the causes of interventions in patients with acute limb ischemia (ALI), the time lapse of presentation, and the outcome. Study Design: An observational study. Methodology: All delayed acute limb ischemia cases (presenting later than 6 hours after the onset of symptoms) were included in the study. Cases of ALI secondary to accidental trauma were excluded except those of iatrogenic trauma like patients with intravenous drug abuse and intra-arterial accidental drug infiltration. Patients' demographic data, clinical history, aetiology, examination findings, and treatment data; including type of surgery, level of amputation, adjunctive treatment were recorded. Results: Total number of delayed ALI cases was 147. Mean age was 59.52 ±17.77 years. Seventy-five (51%) were females while 72(49%) were males. The right lower limb was involved in 56(38%) cases. A hundred (68%) thromboembolectomies were successful and limbs were saved, while 19(12.9%) had failure after the procedure. Three (2%) patients expired within 24 hours of thromboembolectomy. Twenty-five (17%) had frank gangrene at presentation and ended up in amputations while 122 (82.9%) had questionable viability and underwent limb salvage procedures. Conclusion: Delayed presentation of ALI is very common; timely management with effective thromboembolectomies can save limbs in most of the patients. (author)