Non-traumatic acuteischemiaof the lower limbs:Report of 112 cases

##plugins.themes.academic_pro.article.main##

Hamid Jiber
Tarik Abaaziz
Abdellatif Bouarhruom

Abstract

Introduction: Acute limb ischemia is a common pathology. Etiological diagnosis is not always easy to make, and the prognosis depends mainly
on the underlying cause and time management.
Aim: To report the experience of our service, and analyze the different aspects of ischemia and their support in the light of a review of the literature.
Methods: It is a retrospective study, from January 2009 to December 2013, with 112 hospitalized patients in our service for management of acute
lower limb ischemia. Were excluded all patients admitted for trophic disorders and ischemia secondary to trauma. Were analyzed elements
diagnosis and etiologic and therapeutic means.
Results: Epidemiological data were collected. The reason for consultation was a coldness of member in 70% cases, pain in 79% cases, cyanosis
in 56% of cases, pallor in 32% of patients and paralysis in 12% cases. In 25% of cases it was a consumed ischemia. Involvement of the left lower
limb was dominant with 58% and bilateral involvement is reported in two cases. Doppler ultrasound was performed in 55% and CT angiography
in 20% of cases. The origin was embolic in 85% of cases, atherosclerotic vascular disease in 8 case and a blue phlebitis in 6 case. We realized
28 amputations and we deplore seven deaths.
Conclusion: Acute ischemia of the lower limbs are more frequent than those of the upper limbs, they are serious and unpredictable course. An
active and early approach to this pathology improves prognosis and avoid a disastrous outcome.

Keywords:

Lower limb; ischemia; embolectomy; amputation; anticoagulation

##plugins.themes.academic_pro.article.details##

References

  1. V. Piriou, M. Closon, P. Feugier. Prise en charge en urgence d'un patient en ischémie aiguë des membres inférieurs. EMC médecine d'urgence 2008.
  2. Surowiec SM, Isiklar H, Sreeram S, Weiss VJ, Lumsden AB. Acute occlusion of the abdominal aorta. Am J Surg 1998;176:193-7.
  3. http://medecine-vasculaire.angioweb.org
  4. Clagett GP, Sobel M, Jackson MR, LipGY,TangelderM,Verhaeghe R. Antithrombotic therapy in peripheral arterial occlusive disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl3): 609S-626S.
  5. Wright JG, Kerr JC, Valeri CR, Hobson 2nd RW. Heparin decreases ischemia-reperfusion injury in isolated canine gracilis model. Arch Surg 1988; 123: 470-2.
  6. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): TransAtlantic Inter-Society Consensus and Vascular Disease Foundation. Circulation 2006; 113: e463-e654.
  7. F. Bacourt, J.-L. Lasry. Embolies artérielle des membres. EMC-Cardiologie-Angéiologie 2005; 2: 504-514.
  8. Esato K, Nakano H, Ohara M, Nomura S, Mohri H. Methods of suppression of myonephropathic metabolic syndrome. J CardiovascSurg (Torino) 1985; 26: 473-8.
  9. Utoh J, Goto H, Hirata T, Hara M, Moriyama S, Ideta I, et al. Lifethreatening reperfusion injury in skeletal muscle: a simple technique to control critical hyperkalemia. J CardiovascSurg(Torino) 1998;39: 651-4.