Đánh giá kết quả điều trị thiếu máu chi dưới cấp tính

Abstract

Acute lower limb ischemia is a vascular emergency that requires prompt intervention because of the high risk of limb loss or, more severely, death. Revascularization strategies include medical therapy, open vascular surgery, endovascular intervention, or limb amputation in cases of irreversible ischemia. Medical treatment and open surgery have long been established, whereas endovascular intervention has been introduced more recently. However, it has shown promising results in limb salvage for vascular diseases in general and for acute lower limb ischemia in particular. Objective: To evaluate revascularization outcomes, limb salvage rates, and the rate of primary amputation among different treatment modalities in patients with acute lower limb ischemia at a single center. Subject and method: A descriptive case-series study was conducted in patients with acute lower limb ischemia who underwent surgical treatment at the Department of Thoracic and Vascular Surgery, University Medical Center Ho Chi Minh City. Medical records of 91 patients (01/2021-01/2024) were retrospectively reviewed for baseline characteristics, clinical and paraclinical features, and treatment techniques. The primary outcomes were limb salvage rate and postoperative complications at 1 year. Result: A total of 91 patients underwent surgical treatment, with a mean age of 59.9 years; males predominated (male/female = 66/25). Treatment modalities included open arterial thrombectomy (n = 44), endovascular intervention (n = 19), thrombectomy combined with arterial bypass (n = 6), and primary amputation (n = 22). The wound healing and limb salvage rate at 12 months in the revascularization groups was 100%. The 30-day primary patency rates were comparable between the thrombectomy group (97%) and the endovascular group (95%). At 1 year, primary patency was 54% in the thrombectomy group and 51% in the endovascular group. No complications were observed in patients treated with endovascular revascularization. One death occurred among the 22 patients undergoing primary amputation, attributable to acute myocardial infarction. Conclusion: All patients with acute lower limb ischemia were indicated for urgent revascularization. The primary amputation rate was 24.2%, and the wound healing rate at 1 year was 100%. No serious complications occurred in the endovascular intervention group. One-year primary patency rates were comparable between open thrombectomy and endovascular treatment.