A Population‐Based Study of Incidence, Presentation, Treatment and Short‐Term Outcomes of Acute Thromboembolic Ischemia in the Lower Limbs

Vollständiger Abstract

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ABSTRACT Objectives To investigate the current epidemiology and short‐term outcomes in patients with acute lower limb ischemia (ALI) in a well‐defined Norwegian population. Methods A retrospective, single‐center, observational cohort study in a defined population catchment area. All patients with ALI from the catchment area were included in the period from January 2000 to December 2019. Age‐ and sex‐adjusted incidence rates were calculated using population demographics from Statistics Norway. Results A total of 359 patients were identified, and 356 (99.2%) were included in the analyses. Two‐thirds were males ( n = 216, 60.7%), with males presenting at a younger age than females (median age 71, quartiles 63–81 yrs vs. median age 79 quartiles 67–87; respectively; p < 0.001). The age‐ and sex‐adjusted incidence rate for the period was 7.9/100.000/year (95% confidence interval 7.1–8.8) with no significant change throughout the period. Patient distribution according to Rutherford classification was 110 (31%) class 1, 130 (36.6%) class 2a, 100 (28.2%) class 2b and 15 (4.2%) class 3. The level of occlusion was supra‐inguinal in 105 patients (29.5%) and infra‐inguinal in 251 (70.5%). Thrombosis was the most common cause of ischemia, observed in 243 patients (68.3%). Bilateral ischemia was recorded in 21 (5.9%) patients. In 196 (55.1%) the treatment was surgical, in 135 (37.9%) endovascular. Four patients (1.1%) underwent primary amputation, whereas 11 (3.1%) and 10 (2.8%) were managed with conservative or palliative treatment, respectively. In the first 90 days, major adverse limb events were noted in 115 patients (32.3%) and general complications in 73 (20.5%). Overall, a major amputation was performed in 47 (13.2%) within 90‐days. 90‐days mortality was 78 (21.9%). Conclusion The incidence of ALI remained stable over the study period in this defined Nordic population, although embolic occlusions became increasingly common. ALI remained associated with substantial short‐term morbidity and mortality, and females presented with more advanced ischemia and poorer amputation‐free survival.