Gregory J. Landry, Rakendu Shukla, Auddri Rahman, Amir F. Azarbal, Timothy K. Liem, Erica L. Mitchell, Gregory L. Moneta
Oregon Health & Science University, Portland, OR.
OBJECTIVES: The association between demographic and echocardiographic findings with the site of cardiogenic peripheral embolization is not known. We sought to determine if cardiogenic emboli have a random distribution or if there are factors that predict site of embolization, limb salvage and mortality.
METHODS: Upper (UE) and lower extremity (LE) emboli were evaluated over a 6-year period. Demographic (i.e., age, gender, smoking, medical comorbidities) and echocardiographic data were analyzed to determine predictors of embolic site. All patients underwent surgical revascularization. Limb salvage and mortality were compared with Kaplan-Meier analysis.
RESULTS: One hundred sixty patients (72 male, 88 female) with presumed cardiogenic emboli were identified, 56 UE (35 right, 21 left) and 104 LE (42 right, 44 left, 18 bilateral). Males had significantly more LE emboli than females (76% vs. 56%) and females more UE (44% vs. 24%, p=0.01). No other demographic factors were statistically different. UE patients were more likely to have atrial fibrillation on admission (50% vs. 30%, p=0.04), while there was a trend toward LE patients having a higher percentage of aortic or mitral valvular disease (47% vs. 31%, p=0.06). Thirty-day limb salvage was higher for UE compared to LE (100% vs. 88%, p=0.02) There was a trend toward higher 30-day mortality in the LE group (14% vs. 5%, p=0.08). One year mortality in both groups was approximately 25%.
CONCLUSIONS: UE emboli are more frequent in women and patients with active atrial fibrillation. LE emboli are more frequent in men and patients with valvular disease and are associated with increased 30-day limb loss and mortality. These findings suggest gender- and cardiac-specific differences in flow dynamics leading to preferential sites of peripheral embolization.
AUTHOR DISCLOSURES: A. F. Azarbal: Nothing to disclose; G. J. Landry: Nothing to disclose; T. K. Liem: Nothing to disclose; E. L. Mitchell: Nothing to disclose; G. L. Moneta: Nothing to disclose; A. Rahman: Nothing to disclose; R. Shukla: Nothing to disclose.
Posted April 2013