Document Detail

After the blue toe: prognosis of noncardiac arterial embolization in the lower extremities.
MedLine Citation:
PMID:  8433428     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To better understand the prognosis of atheroembolic disease, we reviewed the outcomes of 41 patients with embolization to the viscera and lower extremities.
METHODS AND RESULTS: All cases involved emboli that originated from a radiographically identified proximal arterial source. There were 30 men and 11 women (mean age 65 years; mean follow-up time 2 years), and all had been first treated for this condition within the past 6 years. The overall mortality rate was 17% (7/41) and the rate of recurrent embolization 15% (6/41). To compare outcomes associated with supradiaphragmatic versus subdiaphragmatic disease, we defined two groups: group 1 comprised patients (n = 5) in whom the identified embolic source extended above the diaphragm, and group 2 comprised patients (n = 36) in whom the source remained below the diaphragm. The mortality rates in groups 1 and 2 were 60% (3/5) and 11% (4/36), respectively (p < 0.05). Recurrent embolization was also significantly higher in group 1 (60% vs 8%, p < 0.025). There were two amputations in group 1 and six in group 2 (p = not significant). Group 2 patients were then divided into two subgroups: those with limited disease (n = 19) in which the emboli had a single, radiographically identified source (i.e., aneurysm or single area of ulcerated plaque) and those with diffuse disease (n = 17) in which the emboli had multiple, radiographically identified potential sources. In the subgroup of patients with limited disease, no deaths or episodes of recurrent embolization occurred, whereas four deaths and three episodes of recurrent embolization occurred in the subgroup of patients with diffuse disease. The differences in these outcomes, however, were not statistically significant. Thirty selected patients (one from group 1 and 29 from group 2) underwent operation on or bypass of the imputed lesion. Only one (7%) of these 30 patients had recurrent embolization. In contrast, recurrent embolization was noted in four (36%) of the 11 patients who did not have an operation directed at the lesion (p < 0.025). No significant difference in mortality was found between patients who underwent operation and those who did not.
CONCLUSIONS: Patients with atheroemboli have a substantial mortality rate and risk of recurrent embolization, especially if the disease process extends above the diaphragm; but in selected patients, operation may decrease the frequency of recurrence without increasing mortality.
K H Kvilekval; J P Yunis; R A Mason; F Giron
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  17     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1993 Feb 
Date Detail:
Created Date:  1993-03-18     Completed Date:  1993-03-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  328-34; discussion 334-5     Citation Subset:  IM    
Department of Surgery, University Hospital, State University of New York, Stony Brook 11794-8191.
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MeSH Terms
Amputation / statistics & numerical data
Chi-Square Distribution
Embolism / epidemiology,  mortality*,  radiography,  surgery
Leg / blood supply*
Risk Factors
Toes / blood supply*
Viscera / blood supply

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