Abstract: Diagnosis and treatment of Acute Lower Limb Ischemia and its
effect ion treatment results
Degree Project thesis, Programme in Medicine, A. Karlsson, Supervisor; Joakim Nordanstig, 2015,
Sahlgrenska Academy, University of Gothenburg, Sweden.
Objective
Acute Lower Limb Ischemia (ALLI) is a serious condition where an artery of the lower limb
is occluded resulting in impaired blood flow. The condition may lead to death and amputation
and require urgent medical care.
Aim
The purpose of this study was to describe the early chain of care of ALLI patients with
particular emphasis on early detection and the use of Emergency Medical Services (EMS) as
well as administration of Low Molecular Weight Heparin (LMWH).
Methods
The study included 108 patients for whom medical records at the Sahlgrenska University
Hospital were reviewed. All patients treated with a main diagnosis of I74.3 according to ICD-
10 fulfilled inclusion criteria.
Results
Patients transported to the Emergency Department (ED) by EMS differed from those who
were not in several ways. They were 8.5 years older. A history of congestive heart failure and
atrial fibrillation/flutter was more frequent among those who used EMS whereas the opposite
was found with regard to previous Peripheral Arterial Disease (PAD).
The median time from hospital arrival to first physician contact was 52 minutes when ALLI
was suspected by the EMS personnel and 102 minutes if not (p=0.017). The time from
symptom onset to revascularization was shorter when the EMS personnel suspected ALLI, 17
hours compared to 56 hours when not (p=0.011). Administration of LMWH in the ED tended
to be associated with improved outcome.
Conclusion
Patients who use EMS were older and had a more severe co-morbidity than those who did
not. Early detection of ALLI by the EMS personnel was associated with a shorter delay to see
a physician and to revascularization. Early treatment with LMWH might be associated with
improved outcome