Surgical management and outcomes of acute limb ischaemia at 2 referral hospitals in Addis Ababa, Ethiopia: A 3-month prospective study

Abstract

Background

We sought to evaluate risk factors and outcomes for patients undergoing surgical procedures for treatment of acute limb isch­aemia (ALI) in Ethiopia.

Methods

We conducted a hospital-based prospective cohort study of consecutive patients undergoing surgical treatment for ALI at Tikur Anbessa Specialized Hospital and Teklehaimanot General Hospital in Addis Ababa, Ethiopia from 1 January through 31 December 2018. ALI diagnoses were made using Doppler ultrasound or computed tomography angiography and intraoperative findings. Patients were followed for 3 months postoperatively. Logistic regression modelling was conducted to assess the associations of sociodemographic and clinical variables with amputation, postoperative complications, and mortality.

Results

Data were analysed for 102 of 116 patients who underwent surgical procedures for ALI (mean age, 54 years; 67.6% male). Pa­tients presented to hospital after an average of 9 days (range, 1-15 days) after symptom onset. The primary surgical procedures performed were thrombectomy (n=51, 47.2%), primary amputation (n=24, 22.2%), bypass or interposition vascular grafts (n=10, 9.2%), embolectomy (n=10, 9.2%), primary vascular repair (n=7, 6.4%), and femorofemoral graft (n=6, 5.5%). Local and system­ic complications occurred in 35.3% and 17.6%, respectively. Amputation after revascularization surgery was conducted in 33 patients (32.4%). The 30-day amputation and mortality rates were 52.9% and 9.8%, respectively. Variables significantly associ­ated with complications (such as amputation) or death were age greater than 60 years (OR, 3.8; 95% CI, 1.3-11.1; P=0.02), pre­sentation later than 9 days after symptom onset (OR, 4.2; 95% CI, 1.4-13.1; P=0.01), hypertension alone (OR, 2.8; 95% CI, 1.1-6.3; P=0.03), hypertension in combination with diabetes mellitus (OR, 10.2; 95% CI, 1.3-80.1; P=0.03), and other cardiac risk factors (OR, 5.3; 95% CI, 1.1-25.4; P=0.04).

Conclusions

High rates of amputation and postoperative complications occurred among patients surgically treated for ALI at 2 tertiary hos­pitals in Addis Ababa, Ethiopia. Timely detection of ALI and treatment of comorbidities are essential for improving outcomes for patients with surgically treated ALI in this setting.