Subscribe to RSS
Acute Limb Ischemia after Cardiovascular Surgery: A Deadly Duo Combination with High Mortality
Acute limb ischemia (ALI) is a predictor of high morbidity and mortality. Previous studies showed that ALI developed after cardiac surgery may increase mortality.
This study aimed to elucidate the clinical course and identify risk factors contributing to mortality in patients with ALI after cardiovascular surgery.
This is a single-center retrospective cohort study. We analyzed data from 52 patients with ALI after cardiovascular surgery between 2016 and 2020. We evaluated the risk factors for 1-year mortality using Cox proportional hazards regression analysis.
Most of the patients with ALI were male and the median age was 56 years (23–72 years). Most of the patients with ALI had coronary artery diseases. The 1-year mortality rate was 55.8% (n = 29 patients). Multivariable analysis revealed that cardiopulmonary bypass (CPB) time ≥ 100 minutes (hazard ratio [HR]: 3.067, 95% confidence interval [CI]: 1.158–8.120) and postoperative acute kidney injury (HR: 2.927, 95% CI: 1.358–6.305) were significantly increasing the risk of mortality in patients with ALI after an operation. ALI after cardiovascular surgery was associated with high 1-year mortality in our study and long CPB time and postoperative acute kidney injury contributed to the mortality.
Article published online:
13 February 2023
© 2023. International College of Angiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Norgren L, Hiatt WR, Dormandy JA. et al; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 (Suppl. 01) S1-S75
- 2 Rajan DK, Patel NH, Valji K. et al; CIRSE and SIR Standards of Practice Committees. Quality improvement guidelines for percutaneous management of acute limb ischemia. J Vasc Interv Radiol 2009; 20 (07) , Suppl): S208-S218
- 3 Indriani S, Adiarto S, Andriantoro H, Sunu I, Siddiq T, Dakota I. The protective effect of vitamin E for reducing intra-hospital mortality in acute limb ischemia patients. Indones J Cardiol 2021; 42: 4
- 4 Allen RC, Schneider J, Longenecker L, Kosinski AS, Smith III RB, Lumsden AB. Acute lower extremity ischemia after cardiac surgery. Am J Surg 1993; 166 (02) 124-129 , discussion 129
- 5 Kohlman-Trigoboff D, Gongora E, Stanford J, Smith BM. Risk factors associated with acute lower extremity ischemia after coronary revascularization. J Vasc Nurs 2002; 20 (03) 78-83
- 6 Folkert IW, Foley PJ, Wang GJ. et al. Impact of acute postoperative limb ischemia after cardiac and thoracic aortic surgery. J Vasc Surg 2018; 67 (05) 1530-1536.e2
- 7 Dormandy J, Heeck L, Vig S. Acute limb ischemia. Semin Vasc Surg 1999; 12 (02) 148-153
- 8 Mesh CL, Cmolik BL, Van Heekeren DW. et al. Coronary bypass in vascular patients: a relatively high-risk procedure. Ann Vasc Surg 1997; 11 (06) 612-619
- 9 Ng WK, Vedder M, Whitlock RML. et al. Coronary revascularisation in young adults. Eur J Cardiothorac Surg 1997; 11 (04) 732-738
- 10 Madhavan S, Chan S-P, Tan W-C. et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino) 2018; 59 (02) 274-281
- 11 Olivero JJ, Olivero JJ, Nguyen PT, Kagan A. Acute kidney injury after cardiovascular surgery: an overview. Methodist DeBakey Cardiovasc J 2012; 8 (03) 31-36
- 12 Lassnigg A, Schmidlin D, Mouhieddine M. et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15 (06) 1597-1605
- 13 Loef BG, Epema AH, Smilde TD. et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005; 16 (01) 195-200
- 14 Chew STH, Hwang NC. Acute kidney injury after cardiac surgery: a narrative review of the literature. J Cardiothorac Vasc Anesth 2019; 33 (04) 1122-1138
- 15 Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol 2017; 13 (11) 697-711
- 16 Kazimierczak A, Szumiłowicz P, Samad R. et al. Kidney protection therapy in acute limb ischemia [in Polish]. Ann Acad Med Stetin 2013; 59 (02) 7-11
- 17 Fukuda I, Chiyoya M, Taniguchi S, Fukuda W. Acute limb ischemia: contemporary approach. Gen Thorac Cardiovasc Surg 2015; 63 (10) 540-548