Nontraumatic lower-extremity acute arterial ischemia

Background: The outcome of arterial bypass reconstruction in the setting of acute arterial ischemia has not been well defined. Methods: This retrospective review consists of 71 consecutive patients (54 with native arterial thrombosis, 17 with graft thrombosis) who underwent an urgent/emergent arterial bypass reconstruction for acute arterial ischemia with threatened limb viability. Results: The 30-day mortality and major amputation rates were 9.9% and 7.1%, respectively. Death, limb loss, or both, were associated with a paralytic limb ( P = 0.001) and congestive heart failure ( P = 0.03). Overall, 45 of 71 (63%) patients were discharged with limb salvage and ambulatory function. Cumulative graft patency was 77% and 65% at 1 and 2 years, respectively, and closely approximated the 1- and 2-year limb-salvage rates of 76% and 63%, respectively. Conclusions: Arterial bypass reconstructions appear warranted in acute arterial ischemia, in that a majority of patients retain a functional viable limb. Late graft thrombotic complications limit long-term benefit.