Association between clinical and sonographic patterns of major peripheral arterial occlusion among patients presenting with lower limb dry gangrene at a single center in Western Uganda

Abstract

Background: Dry gangrene occurs due to a reduced blood supply in body parts, resulting in gradual necrosis. It is among the leading indications for lower limb amputation; however, in situations where timely access of accurate diagnostic and revascularization services are limited, irrational amputations are performed based on mere physical assessment of a specific occluded major arterial segment, consequently preceded with gangrene recurrence on the same limb stump due to physical examination inaccuracies. Objectives: We assessed the lower limb dry gangrene patterns and analyzed arterial Doppler reports of these cases to determine the associations between dry gangrene patterns and specific occluded major lower limb arteries to elevate the degree of accuracy of physical assessments. Methods: In this cross-sectional study, 36 patients with lower limb dry gangrene were consecutively enrolled. Dry gangrene patterns and Doppler ultrasound reports of the major arteries of the affected lower limbs were assessed. Data were entered in EPIDATA and exported to STATA version 15 for cleaning and analysis. Clinical and sonographic characteristics are summarized as median and frequencies. Odds ratios (ORs) were tabulated and reported relating the dry gangrene patterns and major arterial occlusion levels as a measure of associations; P value < 0.05 were considered statistically significant. Results: Dry gangrenes demarcated on the toes (61.1%), toes–distal foot 27.8%, and toes–proximal foot and leg (11.1%). Doppler ultrasound revealed femoral arteries (38.9%), popliteal (66.7%), and infrapopliteal (88.9%–100%) arterial occlusions. Association between dry gangrenes demarcating toes–proximal foot and leg with femoral arterial occlusions (ORs: 6.2 and 3.2, respectively), whereas dry gangrene demarcating toes and toes–distal foot with popliteal arterial occlusions (OR, 1.6; P value, 0.05). Conclusion: Dry gangrene demarcating the toes–proximal foot and leg has a significant association with femoral arterial occlusions, whereas demarcation at the toes and toes–distal foot are more associated with popliteal arterial occlusions.