Acute and Subacute Ischemia of Lower Limbs: Angiography and Peripheral Hemodynamics

ABSTRACT Objective To identify pretreatment characteristics related to ischemia severity and symptoms duration in patients with acute (ALI) and subacute lower limb ischemia (SLI). Methods Comparative study, a part of prospective, single-arm, single-center trial of 316 consecutive patients with threatened extremities (all-comers, mean age: 70.9±12.0 years, range: 23-96; 184 men) of whom 99. 4 % suffered from acute or subacute supratibial occlusions (target occlusions). Results Multisegmental (supratibial plus infrapopliteal) arterial occlusions were documented in 90.6 % of ALI patients and in 78.1 % of SLI patients with threatened lower extremity. The value of ABI related to the number of occluded tibial arteries. Occlusion locations associated with ALI (IIA+IIB) were the aortoiliac segment and/or profunda femoris. Furthermore, ALI subjects presented additional infrapopliteal occlusion (acute and/or subacute), smaller number of patent tibial arteries and lower ABI. Conclusion Anatomically, the most important factor related to the ischemia severity and symptoms duration was the status of infrapopliteal vascular bed. The number of acutely, subacutely or chronically occluded tibial vessels was related to clinical categories of ALI and SLI and to ABI. This suggests that tibial reperfusion can be essential for the salvage of threatened limb and should be always considered.