[Management and prognosis of acute arterial embolism: a multivariable analysis of 346 patients].

Objective: To evaluate the management of acute arterial embolism (AAE) and its prognostic factors.

Methods: The clinical data of 346 AAE patients treated at our hospital between January 1998 and October 2008 were retrospectively reviewed. The prognostic factors, including age, gender, extremities, location of embolism, ischemic duration, ischemic categories, and therapeutic methods, postoperative complications were evaluated by multivariate Logistic regression analysis.

Results: There were 210 males and 136 females with a mean age of (63 ± 14) years old. Fifty-six patients occurred in the upper extremities and 290 patients in the lower extremities. The causes included cardiogenic embolism (n = 301), vasogenic embolism (n = 33) and unknown origin (n = 12). The duration of ischemia ranged from 1 h to 7 d. Only 44 patients were admitted ≤ 8 h and the remainder > 8 h. The categories of extremity ischemia were level I (n = 17), level IIA (n = 69), level IIB (n = 221) and level III (n = 39). The procedures included embolectomy (n = 280), interventional thrombolysis (n = 19) and conservative treatment (n = 47). Thirteen patients (3.76%) died of complications during the perioperative periods. And 44 (12.72%) underwent amputations and 289 (83.53%) had excellent clinical outcome with extremity salvage. During a 5-year follow-up period, 38 patients had a recurrent embolism. The Logistic regression analysis showed that ischemic duration, ischemic category, therapeutic methods and complications had significant prognostic influences (all P < 0.05). And other factors such as age, gender, extremities and the location of embolism had insignificant influences (all P > 0.05).

Conclusion: Embolectomy is the first-choice therapy for AAE with an excellent outcome. Ischemic duration, ischemic grading, surgical treatment and complications have significant prognostic influences. Systematic medical treatments, such as effective anticoagulation, are vital in the prevention of recurrent AAE.