Emergency care for patients with embolism of the aorta and main limb arteries in St. Petersburg: an analysis of 3498 cases over 50 years

Abstract

The Objective was to study our treatment experience for the past 50 years of patients with acute embolism of the aorta and main arteries of the limbs (EAMAL).Methods and materials. We analyzed our treatment experience of 3498 patients with EAMAL over the past 50 years, from 1971 to 2020. All patients were treated at a single department. It was one of the first vascular surgery departments established in St. Petersburg. All patients were admitted to our clinic in an emergency way, all of them received urgent angiosurgical care.Results. 3091 (88.4 %) patients were operated on, in 2950 (95.4 %) cases the primary operation was revascularization (embolectomy), in 141 (4.6 %) – limb amputation. 2725 (77.9 %) patients were discharged from the hospital with a saved limb, another 160 (4.6 %) – after limb amputation, 614 (17.5 %) died. According to our findings, it was demonstrated that in recent decades there became significant changes in the ethiology of arterial embolism. Nowadays, 92.2 % of patients with EAMAL have atrial fibrillation as an independent disease or as a complication of another pathology. Over the past decades, the incidence of rheumatic heart disease as a direct cause of embolism has decreased by 8 times. Changes in the structure of embologenic diseases are associated primarily with an increase in the proportion of elderly and senile people suffering from severe concomitant diseases. In recent decades, there has been an increase in the number of patients with embolism of the distally located arteries, mainly of the brachial and popliteal arteries, and a decrease in the rate of embolism of the large arterial vessels – the aorta and iliac arteries. Modern approaches have made it possible to optimize treatment, stick to more aggressive tactics, improve surgical techniques, and thereby reduce the overall and postoperative mortality rate by more than 2 times, which is currently 9 % and 7.5 % respectively.Conclusion. Despite modern advances in vascular surgery, EAMAL remains the actual and complex problem of the health care system of St. Petersburg for the past 50 years.

Keywords

• aortic and arterial embolism
• acute limb ischemia
• surgical treatment