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Risk factors and management of arterial emboli of the upper and lower extremities.

AIM
Analysis of risk factors for the outcome of arterial embolism of the extremities (EE).


METHODS
Between 1999 and 2003, all patients (n=200) with an EE diagnosed in various departments of the hospital were recruited and analysed retrospectively (single center study). Exclusion criteria were isolated digital emboli, iatrogenic emboli and arterial thromboses. For statistical analysis was used the multivariate nominal regression.


RESULTS
There were 138 (69%) leg, and 62 (31%) arm, emboli. Preoperative angiography was performed in 88 patients; a total of 119 (59.5%) cases of incomplete ischemia (leg n=69, arm n=50) were seen. The most common cause of the embolism (73%) was atrial fibrillation (AF). One hundred and seventhyt four patients (87%) were treated by primary surgery. The major amputation rate (lower limb) was 4.3%. Additional arterial emboli were seen in 14 (7%). The mortality rate was 13% (upper extremity embolism 4.8%; lower extremity embolism 16.7%; P=0.021). After discharge, 32.2% of the patients received oral anticoagulation, and 37.9% antiplatelet therapy. The statistical analysis identified postoperative cerebral/visceral thromboembolism as independent risk factor for mortality.


CONCLUSIONS
The main risk factor for EE is AF. Hospital mortality is determined by comorbidity and cerebral or visceral embolism. For this reason, effective oral anticoagulation is required, but is possible in only one-third of the patients after discharge.