Diagnosis and treatment of Acute Lower Limb Ischemia and its effect on

Abstract

Abstract: Diagnosis and treatment of Acute Lower Limb Ischemia and its effect ion treatment results Degree Project thesis, Programme in Medicine, A. Karlsson, Supervisor; Joakim Nordanstig, 2015, Sahlgrenska Academy, University of Gothenburg, Sweden. Objective Acute Lower Limb Ischemia (ALLI) is a serious condition where an artery of the lower limb is occluded resulting in impaired blood flow. The condition may lead to death and amputation and require urgent medical care. Aim The purpose of this study was to describe the early chain of care of ALLI patients with particular emphasis on early detection and the use of Emergency Medical Services (EMS) as well as administration of Low Molecular Weight Heparin (LMWH). Methods The study included 108 patients for whom medical records at the Sahlgrenska University Hospital were reviewed. All patients treated with a main diagnosis of I74.3 according to ICD- 10 fulfilled inclusion criteria. Results Patients transported to the Emergency Department (ED) by EMS differed from those who were not in several ways. They were 8.5 years older. A history of congestive heart failure and atrial fibrillation/flutter was more frequent among those who used EMS whereas the opposite was found with regard to previous Peripheral Arterial Disease (PAD). The median time from hospital arrival to first physician contact was 52 minutes when ALLI was suspected by the EMS personnel and 102 minutes if not (p=0.017). The time from symptom onset to revascularization was shorter when the EMS personnel suspected ALLI, 17 hours compared to 56 hours when not (p=0.011). Administration of LMWH in the ED tended to be associated with improved outcome. Conclusion Patients who use EMS were older and had a more severe co-morbidity than those who did not. Early detection of ALLI by the EMS personnel was associated with a shorter delay to see a physician and to revascularization. Early treatment with LMWH might be associated with improved outcome.