The aims of this study were to review the prevalence and outcome of all surgically treated upper and lower limb emboli presenting to one vascular unit in the last 3 years and to compare transthoracic with transesophageal echocardiography for defining the source of the embolus. All patients who underwent surgical embolectomy for acute limb ischemia from January 2001 to June 2004 were reviewed. Transthoracic and transesophageal echocardiography were carried out on a subset of consecutive unselected patients. Forty-two patients, with a mean age of 80 years, underwent surgical embolectomy from January 2001 to June 2004 (M/F 1:1.8): 27 for lower limb ischemia and 15 for upper limb ischemia. Two thirds of these patients were found to be in atrial fibrillation at presentation (n = 28), of whom less than a third were receiving anticoagulants or antiplatelet agents (n = 8). The mean hospital stay was 15 days with 36 patients (86%) being fully anticoagulated before discharge from hospital. The 30-day mortality rate was 11% (n = 3/27) with 5 patients requiring fasciotomies (12%) and 3 patients requiring an amputation of the lower limb (11%). Postoperatively, 34 patients (81%) had transthoracic echocardiography (TTE), which demonstrated a source or potential source for thrombus in 19 (56%). Fifteen patients (36%) had transesophageal echocardiography (TEE), which changed the subsequent management in 3 patients. All patients in whom TEE altered clinical management would have required this investigation if standard clinical guidelines were followed. TEE did not identify any additional patients with cardiac embolic sources that were not detected by TTE. Arterial limb emboli are still prevalent, but limb salvage and mortality rates appear to be improving. Despite clear guidelines on anticoagulation for patients in atrial fibrillation, many are not receiving appropriate treatment. Transthoracic echocardiography is a good screening tool for detecting a potential cardiac source for peripheral embolism, with transesophageal echocardiography being reserved for specific indications.

译文

:这项研究的目的是回顾过去3年中所有接受手术治疗的上肢和下肢栓塞在一个血管内的发生率和结局,并比较经胸和经食道超声心动图检查来确定栓子的来源。回顾性分析了2001年1月至2004年6月所有因急性肢体缺血而行外科手术栓塞切除术的患者。经胸和经食道超声心动图检查是对连续的未选择患者的子集进行的。 2001年1月至2004年6月,平均年龄为80岁的42例患者接受了手术栓塞切除术(M / F 1:1.8):下肢缺血27例,上肢缺血15例。这些患者中有三分之二被发现存在房颤(n = 28),其中不到三分之一接受抗凝剂或抗血小板药物(n = 8)。平均住院时间为15天,其中36例患者(86%)在出院前已充分抗凝。 30天死亡率为11%(n = 3/27),其中5例需要行筋膜切开术(12%),3例需要下肢截肢(11%)。术后34例(81%)患者经胸超声心动图(TTE),其中19例(56%)证明有血栓来源或潜在来源。 15例患者(36%)进行了食管超声心动图检查(TEE),这改变了3例患者的后续治疗方法。如果遵循标准的临床指南,所有TEE改变了临床管理的患者都需要进行此项调查。 TEE并未发现TTE未发现的其他心脏栓塞患者。动脉肢体栓塞仍很普遍,但肢体抢救和死亡率似乎正在提高。尽管对房颤患者的抗凝治疗有明确的指导原则,但许多人并未得到适当的治疗。经胸超声心动图检查是一种很好的筛查工具,可用于检测周围性栓塞的潜在心脏源,保留经食道超声心动图检查以用于特定适应症。

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