Management of acute thromboembolic limb ischemia.
Acute arterial occlusion affecting the extremities remains a significant cause of death and limb loss. Our approach to the management of these patients has been selective, and it is based upon a clinical distinction between embolism and thrombosis. Patients with acute embolic occlusion are treated with prompt embolectomy. Patients with thrombosis are given a course of heparin therapy, followed by elective arterial repair if necessary. Deterioration of the limb is an indication for emergency reconstruction, and nonviable limbs are amputated early. This approach to treatment was assessed in a 1-year prospective study, involving 29 patients with embolism and 50 patients with thrombosis. The initial diagnosis was found to be incorrect for seven patients (8.9%). Of the patients with embolism, four died (13.8%) and three required amputation (10.4%). There were six deaths (12%) among the patients with thrombosis, but eleven required amputation (22%), and in seven of these amputation was the definitive treatment. We have concluded that the selective use of surgery is an appropriate method of treatment for patients with acute thromboembolic limb ischemia.