Anatomical localization of arterial thrombosis in patients with acute lower limb ischemia secondary to atrial fibrillation: implications for surgical treatment and outcome

BACKGROUND: Atrial fibrillation (AF) is a common cause of emboli in peripheral arteries causing acute lower limb ischemia (ALI). The aim of this study was to investigate the anatomic sites of arterial thrombosis in patients with atrial fibrillation who underwent surgical revascularization, assuming that the type of vascular occlusion has a negative impact on limb outcome. METHODS: A retrospective analysis was performed of prospectively collected data from 69 lower limbs of 64 consecutive patients with ALI who were observed between January 2011 and June 2021 and underwent Fogarty thromboembolectomy and other related revascularization procedures. The site of arterial thromboembolism was confirmed by preoperative CT scan with axial and coronal reconstruction. Patients with AF were assigned to group A (N.=23, 27 procedures), whereas patients without atrial fibrillation were assigned to group B (N.=41, 42 procedures). RESULTS: Patients with AF had a higher rate of multiple occlusions affecting the ischemic limb, mainly involving the femorodistal tract, than patients without AF (group A 26% vs. group B 4.8%, P<0.05). Moreover, an unexpected presence of thromboembolic occlusion was noted in the contralateral limb of group A (N.=10, 37%), which was not necessarily related to previous or current symptoms of ALI. Surgical and endovascular revascularization was effective in both groups with low amputation rates at 30 days (group A 3.7%, group B 2.3%, P=ns). CONCLUSIONS: A substantial number of patients with ALI secondary to AF could be affected by multiple sites of arterial embolization. The incidence of distal embolization is higher compared with patients without AF. In the context of a modern multimodal strategy, the presence of AFdid not adversely affect limb outcomes.