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Acute Limb Ischemia

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Evidence-based Therapy in Vascular Surgery

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Abstract

Acute Limb Ischemia demands immediate evaluation by a vascular specialist, since irreversible damages to nerves and muscle tissues may appear within hours. The grade of ischemia is classified by Rutherford. Initial treatment options are open surgical treatment and thrombolysis. A general recommendation for the choice of treatment is non-existent, yet surgical treatment is preferred in patients with motor or severe sensory deficits (grade IIB ischemia).

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References

  • Acosta S, Kuoppala M. Update on intra-arterial thrombolysis in patients with lower limb ischemia. J Cardiovasc Surg (Torino). 2015;56:317–24.

    CAS  Google Scholar 

  • Alonso-Coello P, Bellmunt S, McGorrian C, American College of Chest Physicians, et al. Antithrombotic therapy in peripheral artery disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e669S–90S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:1425–43.

    Article  PubMed  Google Scholar 

  • Baril DT, Patel VI, Judelson DR, Goodney PP, McPhee JT, Hevelone ND, Cronenwett JL, Schanzer A, Vascular Study Group of New England. Outcomes of lower extremity bypass performed for acute limb ischemia. J Vasc Surg. 2013;58:949–56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg. 2014;60:669–77.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berridge DC, Kessel DO, Robertson I. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev. 2013;(6):CD002784.

    Google Scholar 

  • de Donato G, Setacci F, Sirignano P, Galzerano G, Massaroni R, Setacci C. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg. 2014;59:729–36.

    Article  PubMed  Google Scholar 

  • European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, ESC Committee for Practice Guidelines, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.

    Article  Google Scholar 

  • Falkowski A, Poncyljusz W, Samad RA, MokrzyĹ„ski S. Safety and efficacy of ultra-high-dose, short-term thrombolysis with rt-PA for acute lower limb ischemia. Eur J Vasc Endovasc Surg. 2013;46:118–23.

    Article  CAS  PubMed  Google Scholar 

  • Genovese EA, Chaer RA, Taha AG, Marone LK, Avgerinos E, Makaroun MS, Baril DT. Risk factors for long-term mortality and amputation after open and endovascular treatment of acute limb ischemia. Ann Vasc Surg. 2016;30:82–92.

    Article  PubMed  Google Scholar 

  • Grip O, Kuoppala M, Acosta S, Wanhainen A, Akeson J, Björck M. Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. Br J Surg. 2014;101:1105–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Heilmann C, Schmoor C, Siepe M, Schlensak C, Hoh A, Fraedrich G, Beyersdorf F. Controlled reperfusion versus conventional treatment of the acutely ischemic limb: results of a randomized, open-label, multicenter trial. Circ Cardiovasc Interv. 2013;6:417–27.

    Article  CAS  PubMed  Google Scholar 

  • Kashyap VS, Gilani R, Bena JF, Bannazadeh M, Sarac TP. Endovascular therapy for acute limb ischemia. J Vasc Surg. 2011;53:340–6.

    Article  PubMed  Google Scholar 

  • Katsargyris A, Ritter W, Pedraza M, Moehner B, Bruck M, Verhoeven EL. Percutaneous endovascular thrombosuction for acute lower limb ischemia: a 5-year single center experience. J Cardiovasc Surg (Torino). 2015;56:375–81.

    CAS  Google Scholar 

  • Kayssi A, Shaikh F, Roche-Nagle G, Brandao LR, Williams SA, Rubin BB. Management of acute limb ischemia in the pediatric population. J Vasc Surg. 2014;60:106–10.

    Article  PubMed  Google Scholar 

  • Kempe K, Starr B, Stafford JM, Islam A, Mooney A, Lagergren E, Corriere MA, Edwards MS. Results of surgical management of acute thromboembolic lower extremity ischemia. J Vasc Surg. 2014;60:702–7.

    Article  PubMed  Google Scholar 

  • Korabathina R, Weintraub AR, Price LL, Kapur NK, Kimmelstiel CD, Iafrati MD, Ali Tahir SM. Twenty-year analysis of trends in the incidence and in-hospital mortality for lower-extremity arterial thromboembolism. Circulation. 2013;128:115–21.

    Article  CAS  PubMed  Google Scholar 

  • Koraen L, Kuoppala M, Acosta S, Wahlgren CM. Thrombolysis for lower extremity bypass graft occlusion. J Vasc Surg. 2011;54:1339–44.

    Article  PubMed  Google Scholar 

  • MarquĂ©s de Marino P, MartĂ­nez LĂłpez I, Revuelta Suero S, Hernández Mateo MM, Cernuda Artero I, Cabrero Fernández M, Serrano Hernando FJ. Results of infrainguinal bypass in acute limb ischaemia. Eur J Vasc Endovasc Surg. 2016;51:824–30.

    Article  PubMed  Google Scholar 

  • Matos JM, Fajardo A, Dalsing MC, Motaganahalli R, Akingba GA, Murphy MP. Evidence for nonoperative management of acute limb ischemia in infants. J Vasc Surg. 2012;55:1156–9.

    Article  PubMed  Google Scholar 

  • Morris-Stiff G, Lewis MH. Surgical treatment of acute limb ischaemia in the presence of malignancy. Int J Surg. 2010;8:233–5.

    Article  PubMed  Google Scholar 

  • Mouhayar E, Tayar J, Fasulo M, Aoun R, Massey M, Abi-Aad S, Iliescu C, Ahrar K, Huynh T. Outcome of acute limb ischemia in cancer patients. Vasc Med. 2014;19:112–7.

    Article  PubMed  Google Scholar 

  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67.

    Article  PubMed  Google Scholar 

  • Patel NH, Krishnamurthy VN, Kim S, Saad WE, Ganguli S, Walker TG, Nikolic B, CIRSE and SIR Standards of Practice Committees. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia. J Vasc Interv Radiol. 2013;24:3–15.

    Article  PubMed  Google Scholar 

  • Robertson I, Kessel DO, Berridge DC. Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev. 2013;(12):CD001099.

    Google Scholar 

  • Schernthaner MB, Samuels S, Biegler P, Benenati JF, Uthoff H. Ultrasound-accelerated versus standard catheter-directed thrombolysis in 102 patients with acute and subacute limb ischemia. J Vasc Interv Radiol. 2014;25:1149–56.

    Article  PubMed  Google Scholar 

  • Schmidt CA, Rancic Z, Lachat ML, Mayer DO, Veith FJ, Wilhelm MJ. Hypothermic, initially oxygen-free, controlled limb reperfusion for acute limb ischemia. Ann Vasc Surg. 2015;29:560–72.

    Article  PubMed  Google Scholar 

  • Schrijver AM, van Leersum M, Fioole B, Reijnen MM, Hoksbergen AW, Vahl AC, de Vries JP. Dutch randomized trial comparing standard catheter-directed thrombolysis and ultrasound-accelerated thrombolysis for arterial thromboembolic infrainguinal disease (DUET). J Endovasc Ther. 2015;22:87–95.

    Article  PubMed  Google Scholar 

  • Schrijver AM, de Vries JP, van den Heuvel DA, Moll FL. Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts. Ann Vasc Surg. 2016;31:134–42.

    Article  PubMed  Google Scholar 

  • Silverberg D, Yalon T, Reinitz ER, Yakubovitch D, Segev T, Halak M. Acute limb ischemia in cancer patients: aggressive treatment is justified. Vascular. 2015;23:55–61.

    Article  PubMed  Google Scholar 

  • Taha AG, Byrne RM, Avgerinos ED, Marone LK, Makaroun MS, Chaer RA. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg. 2015;61:147–54.

    Article  PubMed  Google Scholar 

  • Tsang JS, Naughton PA, O’Donnell J, Wang TT, Moneley DS, Kelly CJ, Leahy AL. Acute limb ischemia in cancer patients: should we surgically intervene? Ann Vasc Surg. 2011;25:954–60.

    Article  PubMed  Google Scholar 

  • von Allmen RS, Anjum A, Powell JT, Earnshaw JJ. Hospital trends of admissions and procedures for acute leg ischaemia in England, 2000-2011. Ann R Coll Surg Engl. 2015;97:59–62.

    Article  Google Scholar 

  • Wang JC, Kim AH, Kashyap VS. Open surgical or endovascular revascularization for acute limb ischemia. J Vasc Surg. 2016;63:270–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Vascular Medicine, University Heart and Vascular Center at University Clinics Hamburg–Eppendorf, Hamburg, Germany

    E. Sebastian Debus

  2. Former Medical Director, Community Hospital Altoetting-Burghausen, Burghausen, Germany

    Reinhart T. Grundmann

Authors
  1. E. Sebastian Debus
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  2. Reinhart T. Grundmann
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Debus, E.S., Grundmann, R.T. (2017). Acute Limb Ischemia. In: Evidence-based Therapy in Vascular Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47148-8_10

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  • DOI: https://doi.org/10.1007/978-3-319-47148-8_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47147-1

  • Online ISBN: 978-3-319-47148-8

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