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• W2022763809 abstract "Only two decades ago, many patients with acute lower a new era in 1963. During the sixties and seventies, limb ischaemia routinely underwent emergency ar- the number of patients diagnosed with acute limb terial thromboembolectomy with only an electro- ischaemia increased, probably partly due to an increasing cardiogram as a preoperative investigation. In the number of elderly people in our society. The age-adjusted unit* of the authors such management was used in number of arterial thromboembolectomies in Sweden 90% of acute lower limb ischaemia cases, resulting in increased yearly by 3% and 7.5% for women and men, only 55% one-month survival without amputation. respectively, during the years 1969‐1983. 4 This trend Similar results were reported elsewhere. 1 In 1997, 1054 ended in the mid-eighties when the number of arterial acute lower limb ischaemia events were reported to thromboembolectomies in Sweden levelled off, thereSWEDVASC, the Swedish National Vascular Registry. after decreasing. In 1997, the number was approximately Forty-four per cent of these were treated with arterial 50% of that reported for 1984 (in-patient register, Swedish thromboembolectomy, 31% with thrombolysis, 7% National Board of Health and Welfare). Several exwith femorodistal bypass, and the rest were graft planations for these changes can be found. thrombectomies. Reocclusion and mortality rates Two decades ago it became apparent that the balwithin 1 month were 9% and 15% for embolic and loon-tipped catheter was not the saviour for all acutely 24% and 14%, respectively, for thrombosis cases. What ischaemic limbs. The outcome as regards limb and life has happened with management strategies over the was often poor after thromboembolectomy, especially last two decades? in patients with severe atherosclerotic occlusive Ever since the first successful embolectomies in 1911, disease. 5,6 By contrast, embolectomy in non-atheromanagement strategies have changed back and forth sclerotic arteries was usually successful. 6 Differentiafrom non-surgical to surgical treatment. In a Swedish tion between embolic and thrombotic events was series of 382 patients operated upon during the two therefore suggested, the latter preferably being treated decades after 1911, only 23% survived without am- with a semi-elective bypass procedure. 7 A case was also putation. 2 Due to these rather poor results, more con- made for non-surgical management using heparin. 8 servative strategies were advocated. The introduction Another approach based on an assessment of the of anticoagulants again popularised non-surgical man- severity of the ischaemia was suggested from this agement. Results were similar to or better than for institution* and others. 6 With this policy, acute ischsurgical management. 3 During the fifties, surgical treat- aemia patients with severe ischaemia underwent emerment was used increasingly often, but it was the gency surgery. The others, irrespective of the presumed" @default.
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• W2022763809 title "Management of Acute Limb Ischaemia Over Two Decades: The Swedish Experience" @default.
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• W2022763809 doi "https://doi.org/10.1053/ejvs.1999.0881" @default.
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