Amputation risk and survival after embolectomy for acute arterial ischaemia. Time trends in a defined Swedish population

Abstract

Objectives: To assess the outcome of embolectomy over an 19 year period.

Methods: Time trends in the outcome of acute arterial thrombo-embolectomy of the extremities were analysed in a population-based cohort of 1190 patients operated on between 1965-83.

Results: A total of 262 (22%) initial amputations were performed. The limb salvage rates at 5 years postoperatively were lower between 1975-79 (61%) than between 1965-69 (81%). A proportional hazards model revealed a relative hazard (RH) of amputation of 2.2 (95% confidence interval (CI) 1.3-3.3) for 1975-79 compared with 1965-69. Operation at any district hospital entailed a 70% higher risk of amputation (RH 1.7; 95% CI 1.3-2.5) compared with the University hospital. The relative survival rate at 5 years postoperatively decreased towards the end of the study period (33% between 1975-79 compared with 43% between 1965-69). Younger age-groups had a considerably lower risk of death in the University hospital compared with the county and district hospitals.

Conclusions: Contrary to the results in other hospital based reports no improvement in amputation or survival rates since 1965 could be demonstrated in this large series with no patient selection.