Ann Vasc Med | Volume 1, Issue 1 | Research Article | Open Access
Francesco Zaraca1*, Andrea Ponzoni2, Carlo Stringari1, Juliane A Ebner1 and Heinrich Ebner1
1Department of Vascular and Thoracic Surgery, Regional Hospital Bozen, Italy
2Department of ICT, Institute Zooprofilattico Sperimentale delle Venezie, Italy
*Correspondance to: Francesco ZaracaFulltext PDF
Aim: Completion angiography is useful after thromboembolectomy for lower limb ischemia. In this study the authors prospectively assessed the vascular surgeon's accuracy in predicting the need for intraoperative angiography.
Methods: Details of patients with acute lower limb ischemia due to native vessel occlusion were prospectively recorded over a 4-year period in a central hospital vascular unit setting. The patients were prospectively randomised to perform either intraoperative angiography (group A) or not (group B). Eligible patients for randomisation had to meet the 3 predefined criteria to be enrolled: a good capillary refilling, at least one palpable arterial pulse of foot and a good foot skin hyperaemia after revascularization. The upper normal limit for capillary refill was considered 3 seconds. When the clinical appearance of the foot did not meet the predefined criteria the patients were not randomised and on-table angiography was directly performed (group C).In order to calculate the positive and negative predictive values and sensitivity of intraoperative clinical findings in detecting residual clots, we compared groups A and C. In order to determine reliability of the intraoperative clinical factors in predicting outcome, results of the randomised groups (A and B) were analysed in terms of reocclusion, amputation and mortality at 24 months.
Results: A total of 102 consecutive patients underwent 110 lower limb thromboembolectomies for acute ischemia. 75 procedures were randomised in the present study: 36 were randomised to the intraoperative angiography group (group A) and 39 to no intraoperative angiography group (group B). 35 procedures were not randomised (group C). The positive and negative predictive values and sensitivity of the 3 intraoperative criteria were respectively 26%, 83% and 60%. In group a extension of the procedure, based on data acquired from the on table angiography, was necessary in 16.7% of patients (6/36). At 24 months after surgery, group A resulted in a lower incidence of reocclusion (8.3%) in comparison with group B (28.2%) (p=0.02), whereas there was no statistical difference between the 2 groups in terms of amputation (6.7% vs. 10.7%; p=0.60) nor of mortality (53.3% vs. 55.7%; p=0.84). Conclusions: Intraoperative clinical findings are not reliable in predicting postoperative outcome during surgery for acute lower limb ischemia. The positive and negative predictive values and sensitivity of these intraoperative criteria compared to angiography are poor.Routine use of intraoperative angiography after embolectomy for lower limb acute arterial occlusion, compared to selective use, results in a lower reocclusion rate at 24 months (p=0.02).
Completion Angiogram; Acute Lower Limb Ischemia; Thromboembolectomy
Zaraca F, Ponzoni A, Stringari C, Ebner JA, Ebner H. Intraoperative Clinical Findings vs Completion Angiography during Thromboembolectomy for Acute Lower Limb Ischemia: Analysis of Outcomes. Ann Vasc Med. 2018;1(1):1003.