Peripheral Arterial Emboli and Factors in Their Recurrence Rate

Silvers, Lawrence W.; Royster, Thomas S.; Mulcare, Robert J.

doi:10.1097/00000658-198008000-00018

Cited by 36 publications

(10 citation statements)

References 2 publications

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“…Bhagwan et al (1978) 14 , treated 122patients with arterial embolectomy, limb salvage was 90%for those patients operated on within 12hours of onset of symptoms. In another studies 10,15,16 , the limb salvage rates were comparable to our study. Embolectomies were performed in all limbs regardless the time of presentation if the limb still viable.…”

Section: Discussionsupporting

confidence: 89%

The Outcome of Acute Thromboembolic Arterial Occlusion

Benyan¹,

Al-Ali²,

Mudhafer³

et al. 2014

Basrah Journal of Surgery

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Section: Discussionsupporting

confidence: 89%

The Outcome of Acute Thromboembolic Arterial Occlusion

Benyan¹,

Al-Ali²,

Mudhafer³

et al. 2014

Basrah Journal of Surgery

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“…2,3 The overwhelming majority of arterial limb emboli originated from the heart. This is obvious in our study as well as in previous series, [1][2][3] though our study showed a few interesting features. Rheumatic valvular disease was responsible for 18.7% of all emboli.…”

Section: Discussionsupporting

confidence: 88%

Arterial Embolism of Limbs: Recent Experience in a Saudi Referral Vascular Unit

Zahrani

1991

Vascular Surgery

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Thirty-two patients with 40 acutely ischemic limbs due to arterial embolism were studied over a two-year period to define the pattern of etiologic factors and problems in management. The mean age was fifty-five years (range eight to one hundred), and the male-to-female ratio was almost 1:1. Only 8 patients (25%) presented within eight hours of onset. Lower limb ischemia occurred in 29 patients (90.6%), and the right side was affected in 16 limbs (55.2%). Large-vessel occlusion occurred in 21 patients (65.6%) and was usually treated by embolectomy. Small-vessel occlusion was encountered in 11 patients (34.4%), and embolectomy was performed in 3 of these patients (27.3%) Emboli arose from the heart in 20 cases (62.5 %) and rheumatic valvular heart disease was found in 6 patients (18.7%). Noncardiac sources were detected in 12 patients (37.5%). In 12.5 % of the cases, the author failed to determine a source. Six patients (18.7%) expired; death was associated mainly with the presence of a delayed, large embolus and myocardial ischemia. The author managed to save 22 limbs (55%). Amputation was performed on 6 limbs (15%). The author concludes that the pattern of etiologic factors of arterial embolism in Saudi Arabia is changing to one similar to that encountered in Western countries. Earlier detection and referral of cases is recommended in order to save more limbs in future.

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“…The most common cause of early death in patients with AF was neurological damage from the initial stroke, as might be anticipated, since they had more severe strokes with a predominantly cortical localization. 11,17,19,21,28 …”

Section: Discussionmentioning

confidence: 99%

Risk of Early Death and Recurrent Stroke and Effect of Heparin in 3169 Patients With Acute Ischemic Stroke and Atrial Fibrillation in the International Stroke Trial

Saxena

Lewis

Berge

et al. 2001

Stroke

248

113

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Background and Purpose — We sought to investigate the apparently high risk of early death after an ischemic stroke among patients with atrial fibrillation (AF), identify the main factors associated with early death, and assess the effect of treatment with different doses of subcutaneous unfractionated heparin (UFH) given within 48 hours. Methods — We studied the occurrence of major clinical events within 14 days among 18 451 patients from the International Stroke Trial, first for all treatment groups combined. Then, among patients with AF, we examined the effects of treatment with subcutaneous UFH started within 48 hours and continued until 14 days after stroke onset. Results — A total of 3169 patients (17%) had AF. Seven hundred eighty-four patients were allocated to UFH 12 500 IU SC BID, 773 to UFH 5000 IU SC BID, and 1612 to no heparin. Within each of these groups, half of the patients were randomly assigned to aspirin 300 mg once daily. Compared with patients without AF, patients with AF were more likely to be female (56% versus 45%), to be old (mean age, 78 versus 71 years), to have an infarct on prerandomization CT (57% versus 47%), and to have impaired consciousness (37% versus 20%). The initial ischemic stroke type was more often a large-artery infarct (36% versus 21%). A lacunar stroke syndrome was less common (13% versus 26%). Death within 14 days was more common in patients with AF (17% versus 8%) and more often attributed to neurological damage from the initial stroke (10% versus 4%). The frequency of recurrent ischemic or undefined stroke was not significantly different (3.9% versus 3.3%). The proportion of AF patients with further events within 14 days allocated to UFH 12 500 IU (n=784), UFH 5000 IU (n=773), and to no-heparin (n=1612) groups were as follows: ischemic stroke, 2.3%, 3.4%, 4.9% ( P =0.001); hemorrhagic stroke, 2.8%, 1.3%, 0.4% ( P <0.0001); and any stroke or death, 18.8%, 19.4% and 20.7% ( P =0.3), respectively. No effect of heparin on the proportion of patients dead or dependent at 6 months was apparent. Conclusions — Acute ischemic stroke patients with AF have a higher risk of early death, which can be explained by older age and larger infarcts but not by a higher risk of early recurrent ischemic stroke, although slightly more patients with AF died from a fatal recurrent stroke of ischemic or unknown type (1.3% versus 0.9%). In patients with AF the absolute risk of early recurrent stroke is low, and there is no net advantage to treatment with heparin. These data do not support the widespread use of intensive heparin regimens in the acute phase of ischemic stroke associated with AF.

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Peripheral Arterial Emboli and Factors in Their Recurrence Rate

Cited by 36 publications

References 2 publications

The Outcome of Acute Thromboembolic Arterial Occlusion

The Outcome of Acute Thromboembolic Arterial Occlusion

Arterial Embolism of Limbs: Recent Experience in a Saudi Referral Vascular Unit

Risk of Early Death and Recurrent Stroke and Effect of Heparin in 3169 Patients With Acute Ischemic Stroke and Atrial Fibrillation in the International Stroke Trial

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