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Int J Angiol
DOI: 10.1055/a-2760-9820
Letter to the Editor

Broadening the Risk Model for Acute Limb Ischemia in Postcardiac Surgery Patients

Authors

  • Gökhan Ceyhun 

    1   Department of Cardiology, Ataturk University Faculty of Medicine, Erzurum, Türkiye
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Dear Editor,

We read with interest the article by Indriani et al.[1] on acute limb ischemia (ALI) after cardiovascular surgery. The authors demonstrated that prolonged cardiopulmonary bypass (CPB) time and postoperative acute kidney injury (AKI) were associated with increased 1-year mortality. This observation is clinically important, as ALI after cardiac surgery is an uncommon but highly lethal complication.

While we agree that CPB duration and AKI are key contributors, several additional clinical factors also appear to play a role in prognosis. Earlier reports have emphasized that advanced age, reduced left ventricular ejection fraction, chronic kidney disease, and urgent or emergency surgery are strongly associated with adverse outcomes in patients who develop ALI following cardiovascular procedures.[2] [3] [4] These parameters often reflect the frailty and the heavy comorbidity burden typically seen in the population undergoing such high-risk cardiovascular operations.

Moreover, mechanical circulatory support devices such as extracorporeal membrane oxygenation and intra-aortic balloon pump, although life-saving in critically ill patients, have consistently been identified as risk factors for postoperative limb ischemia and higher mortality.[5] Beyond mechanical support, systemic complications such as sepsis and metabolic disturbances, as well as reperfusion injury related to reperfusion, further aggravate the course of ALI. The release of potassium, hydrogen ions, and myoglobin during reperfusion.[6]

Taken together, these observations suggest that ALI in the postoperative setting should not be considered an isolated vascular problem but rather part of a systemic syndrome that reflects both intraoperative stress and underlying comorbid conditions. A comprehensive risk model that integrates CPB time, renal outcomes, hemodynamic support, and patient-specific comorbidities may provide a more accurate tool for predicting prognosis. Prospective multicenter studies are warranted to validate such risk models and tools.

We commend the authors for drawing attention to this topic and hope that future investigations will incorporate broader clinical variables to guide preventive and therapeutic strategies.



Publication History

Received: 21 September 2025

Accepted: 01 December 2025

Article published online:
17 December 2025

© 2025. International College of Angiology. This article is published by Thieme.

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