Acute Limb Ischemia Presentation and Outcome Among Cardiac Patients in Resource-Limited Setup, Single Institution Experience, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2024
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Date
2024-12-13
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Addis Ababa University
Abstract
Background: Acute Limb Ischemia (ALI) is a sudden drop in limb perfusion, posing a threat to viability. Cardiac conditions such as atrial fibrillation, valvular disease, and ischemic heart disease are major risk factors. In resource-limited settings like Tikur Anbessa Specialized Hospital, understanding ALI presentation and outcomes in cardiac patients is crucial for improving management and reducing morbidity and mortality.
Objectives: This study assesses ALI presentation, interventions, and outcomes in cardiac patients, identifying factors linked to poor prognosis, including amputation and mortality rates.
Methods: A three-year retrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital. Data were extracted from medical records, and statistical analysis, including logistic regression, was performed using SPSS.
Results: The study included 82 cardiac patients with ALI. The 30-day mortality rate was 17.1%, and in-hospital mortality was 12.2%. The total amputation rate was 37.8%, predominantly above-knee (77.4%). Limb viability at 30 days was 47.1%. Severe mitral stenosis increased embolic ALI risk sixfold (p = 0.003) but was associated with successful revascularization and lower amputation risk. Cardiac thrombi were strongly linked to embolic ALI (p < 0.001). Early intervention (72 hours) increased the odds of limb loss 12.6-fold (p = 0.002). Pulmonary complications significantly increased in-hospital mortality (p < 0.001).
Conclusion and Recommendations: ALI in cardiac patients carries high amputation and mortality risks, particularly in resource-limited settings. Early intervention and anticoagulation improve outcomes. Severe mitral stenosis and cardiac thrombi are key predictors of embolic ALI, emphasizing the need for early cardiac screening. Timely referrals, vascular services, and public awareness on early symptoms can enhance patient outcomes.
Keywords: Acute Limb Ischemia, Cardiac Disease, Amputation, Thromboembolism, Atrial Fibrillation, Resource-Limited Setting, Vascular Surgery, Revascularization, Embolism, Ischemic Heart Disease, Mitral Stenosis, Peripheral Arterial Disease, Pulmonary Complications, Anticoagulation, Limb viability.
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Keywords
Acute Limb Ischemia Cardiac Disease AmputationThromboembolism Atrial Fibrillation Resource-Limited Setting Vascular Surgery Revascularization
EmbolismIschemic Heart DiseaseMitral StenosisPeripheral Arterial Disease
Pulmonary ComplicationsAnticoagulation Limb viability