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Med Arch. 2010; 64(6): 328-331


Evaluation of Medical and Surgical Management of Critical Extremity Ischemia Caused by Atherothrombosis

Nedzad Rustempasic, Emir Solakovic, Medzida Rustempasic, Izet Masic.

Abstract
Aim: To assess efficacy of surgical and medical (conservative) treatment of acute exacerbation of chronic extremity ischemia by evaluating their early therapeutic outcomes in terms of mortality, extremity amputation and reamputation rate, limb salvage rate and length of hospitalization period. Patients and methods: Patients were divided into two groups based on method used for the treatment of critical ischemia. Group A consisted of 40 patients that were subjected to surgical treatment of critical extremity ischemia during period 2004-2009. All patients were subjected to thrombectomy in local anesthesia ( 2% lidocaine ) as initial step of treatment protocol. Urgent Seldinger angiography was performed for all patients that have undergone thrombectomy regardless of successfulness of thrombectomy. Based on angiography findings decision was made about further definitive treatment. It consisted of either using antiaggregating drugs (acetyl salicylic acid; 150 mg/day ) if no significant postthrombectomy stenotic lesion was found or subjecting patients to further surgical revascularization in the form of bypass were significant stenosis or occlusion was identified. Group B consisted of 40 patients; all of them received conventional heparin anticoagulation therapy supplemented with vasoactive infusion treatment (Pentoxyohylline 300 mg/day) during period 1998-2004. On the third day of hospitalization oral anticoagulation (Sintrom) was included in the therapy protocol using dosage 2-8mg/day in order to achieve INR 2-4, once therapeutic INR was obtained heparin was withdrawn. Study was clinical, designed as retrospective prospective and was conducted at the Clinic for vascular surgery in Sarajevo. Results: Mean age in group A was 66,5 years and in group B it was 65,78 years. Lenght of hospital stay in group A was 13,78 days while in group B it was 34,25 days ( P value

Key words: bleeding, omeprazole, peptic ulcer, ranitidine.



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