Evaluation of medical and surgical management of critical extremity XXXX caused by atherothrombosis.

@entity1 @entity63 @entity75 @entity117 @entity3303 @entity432 @entity850
AIM: To assess efficacy of surgical and medical (conservative) treatment of acute exacerbation of chronic extremity @entity63 by evaluating their early therapeutic outcomes in terms of mortality, extremity amputation and reamputation rate, limb salvage rate and length of hospitalization period. @entity1 AND METHODS: @entity1 were divided into two groups based on method used for the treatment of critical @entity63 . Group A consisted of 40 @entity1 that were subjected to surgical treatment of critical extremity @entity63 during period 2004-2009. All @entity1 were subjected to thrombectomy in local anesthesia (2% @entity3303 ) as initial step of treatment protocol. Urgent Seldinger angiography was performed for all @entity1 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 ( @entity117 ; 150 mg/day) if no significant @entity75 was found or subjecting @entity1 to further surgical revascularization in the form of bypass were significant @entity850 or @entity432 was identified. Group B consisted of 40 @entity1 ; 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the therapy protocol using dosage 2-8 mg/day in order to achieve INR 2-4, once therapeutic INR was obtained heparin was withdrawn.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 < 0,001). Limb salvage rate was 70% in group A and 17,5% in group B (P value < 0,001). In group A, nine amputations were performed (22,5%) while in group B we had to perform 38 amputations (95%), P value < 0,001. Only one reamputation was performed in group A (2,5% of @entity1 ) while in group B ten reamputations were performed (25% of @entity1 ). Mortality rate between groups was not statistically significant (P value < 0,077). CONCLUSION: Surgical thrombectomy as introduction to definitive treatment of @entity63 caused by atherothrombosis gives statistically superior results in comparison to conservative treatment.
