Role of Embolectomy in Delayed Presented Acute Lower Limb Ischemia

Introduction Acute limb ischemia (ALI) was defined as a sudden onset of decreased arterial blood flow to an extremity that occurred during the previous 14 days. The usual cause is thromboembolic pathology (Morrison, 2006). ALI is a highly morbid disorder with one-year mortality rate between 16-42% and amputation rates ranging between 11-37% (Tsang et al., 2011; Baril et al., 2013). Revascularization decisions for ALI comprise open revascularization (OR) and endovascular revascularization (ER) (Baril et al., 2014). The tolerance of tissue for anoxia varies with the tissue type and/or the condition of collateral circulation. ALI has been shown to be irreversible after 4 hours of ischemia in muscle, 8hours in nervous tissue, 13 hours in fat, 24 hours in skin and up to 4 days in bone (Ouriel et al., 2005) .Skeletal muscles are recognized to be most susceptible to ischemic injury. Thus, muscle injury is the critical aspect in lower limb ischemic and reperfusion injury Khan and Nadeem (2016). It is well-known that a delay of more than 8 hours increases complications of ischemia in patients with arterial emboli in lower limb. However, previous studies revealed a reduction in complications when the period of ischemic injury exceeds 7 days. Thus, it can be said that delayed surgical intervention after the patient has with stand the first week injury of ischemia with little extremity or tissue damage could be more beneficial (Iyem and Eren, 2009). In the light of this, the present study was designed to evaluate the outcome of delayed arterial embolectomy in patients with diagnosis of late acute lower limb embolic arterial occlusion.