J.Jpn. Surg. Soc.. 82(9): 986-989, 1981

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Report on the annual meeting

PROBLEMS IN SURGICAL TREATMENT FOR ACUTE ARTERIAL OCCLUSIVE LESIONS

A retrospective review on 97 cases with acute arterial occlusive lesion which were underwent reconstructive surgery, from 1960 to 1980, was carried out. All of 16 cases reconstructed within 6 hours after onset were well. Of remainings which underwent reconstruction over 8 hours after onset, 11 died of revascularization syndrome and 24 lost their affected limbs because of no impovement of ischemic symptoms. Ill prognosis of the affected limb after reconstruction was highly related to extension of occlusive lesion. Although limbs with a localized occlusion limited to one atrerial segment were successfully cured of symptoms regardless of the lapse of time after onset, there was high incidence of death or limb amputation in cases with saddle embolism or extensive occlusion beyond three arterial segments, such as ilio-femoro-popliteal occlusion. An experimental study on saddle embolism using dogs revealed that in surgical treatment for cases with saddle embolism or extensive occlusive lesion, washing out of the affected limb with heparinsaline solution before reestablishing blood flow might be an effective procedure preventing ocurrence of revascularization syndrome. The limbs with progressive ischemic symptoms including mottling cyanosis, marked swelling with blister formation, loss of sensory and movement, muscle atrophy with clear demarcation and/or muscle digidity seemed to be indicated to direct limb amputation.

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