Acute arterial thrombosis of the lower extremity. Its natural history contrasted with arterial embolism
R. P. Cambria and W. M. Abbott
We compared a group of 52 patients with acute lower extremity ischemia
secondary to arterial thrombosis with a series of 220 patients with
peripheral embolism who were seen at the Massachusetts General Hospital,
Boston, from 1967 through 1980. The conditions of patients with arterial
thrombosis were misdiagnosed as acute embolism at a rate of 20%. Mortality
in the patients with embolism was significantly higher. While patients with
acute embolism were routinely treated with embolectomy, two thirds of the
patients with thrombotic occlusion required surgery during their initial
hospitalization for ongoing severe ischemia. More than half of these
operations were carried out as emergency procedures. Limb salvage in
surgically treated patients with arterial thrombosis was inferior to that
seen with embolism. Early revascularization for acute thrombosis was
carried out with a 30-day patency rate of 82%. While the mortality
associated with acute thrombosis was significantly lower than that seen
with peripheral embolism, the risk of major amputation was 35%. There
should be no reluctance to proceed with indicated vascular reconstruction
in the setting of acute limb ischemia secondary to arterial thrombosis.
