The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

  • Suci Indriani National Cardiovascular Center Harapan Kita
  • Suko Adiarto
  • Hananto Andriantoro
  • Ismoyo Sunu
  • Taofan Siddiq
  • Iwan Dakota
Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury



Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury.


To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients.


This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality.


A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality.


Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients.

Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury


Download data is not yet available.


1. Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012;366(23):2198-2206.
2. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67.
3. Rajan DK, Patel NH, Valji K, et al. Quality improvement guidelines for percutaneous management of acute limb ischemia. J Vasc Interv Radiol. 2005;16(5):585-595.
4. Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg. 2014;60(3):669-677 e662.
5. Arato E, Kurthy M, Sinay L, et al. Effect of vitamin E on reperfusion injuries during reconstructive vascular operations on lower limbs. Clin Hemorheol Microcirc. 2010;44(2):125-136.
6. Eliason JL, Wakefield TW. Metabolic consequences of acute limb ischemia and their clinical implications. Semin Vasc Surg. 2009;22(1):29-33.
7. Simon F, Oberhuber A, Floros N, et al. Acute Limb Ischemia-Much More Than Just a Lack of Oxygen. Int J Mol Sci. 2018;19(2).
8. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg. 2002;10(6):620-630.
9. Carden DL, Granger DN. Pathophysiology of ischaemia-reperfusion injury. J Pathol. 2000;190(3):255-266.
10. Arato E, Kurthy M, Sinay L, et al. Pathology and diagnostic options of lower limb compartment syndrome. Clin Hemorheol Microcirc. 2009;41(1):1-8.
11. Boyle EM, Jr., Canty TG, Jr., Morgan EN, Yun W, Pohlman TH, Verrier ED. Treating myocardial ischemia-reperfusion injury by targeting endothelial cell transcription. Ann Thorac Surg. 1999;68(5):1949-1953.
12. Brennan P, O'Neill LA. Inhibition of nuclear factor kappaB by direct modification in whole cells--mechanism of action of nordihydroguaiaritic acid, curcumin and thiol modifiers. Biochem Pharmacol. 1998;55(7):965-973.
13. Paludan SR. Synergistic action of pro-inflammatory agents: cellular and molecular aspects. J Leukoc Biol. 2000;67(1):18-25.
14. Nakamura T, Goto M, Matsumoto A, Tanaka I. Inhibition of NF-kappa B transcriptional activity by alpha-tocopheryl succinate. Biofactors. 1998;7(1-2):21-30.
15. Formigli L, Ibba Manneschi L, Tani A, et al. Vitamin E prevents neutrophil accumulation and attenuates tissue damage in ischemic-reperfused human skeletal muscle. Histol Histopathol. 1997;12(3):663-669.
16. Clason AE, Stonebridge PA, Duncan AJ, Nolan B, Jenkins AM, Ruckley CV. Morbidity and mortality in acute lower limb ischaemia: a 5-year review. Eur J Vasc Surg. 1989;3(4):339-343.
17. Allen RC, Schneider J, Longenecker L, Kosinski AS, Smith RB, 3rd, Lumsden AB. Acute lower extremity ischemia after cardiac surgery. Am J Surg. 1993;166(2):124-129; discussion 129.
18. Folkert IW, Foley PJ, Wang GJ, et al. Impact of acute postoperative limb ischemia after cardiac and thoracic aortic surgery. J Vasc Surg. 2018;67(5):1530-1536 e1532.
19. Fukuda I, Chiyoya M, Taniguchi S, Fukuda W. Acute limb ischemia: contemporary approach. Gen Thorac Cardiovasc Surg. 2015;63(10):540-548.
20. Dick F, Li J, Giraud MN, Kalka C, Schmidli J, Tevaearai H. Basic control of reperfusion effectively protects against reperfusion injury in a realistic rodent model of acute limb ischemia. Circulation. 2008;118(19):1920-1928.
21. Oomman A, Sathyamurthy I, Ramachandran P, et al. Profile of female patients undergoing coronary angiogram at a tertiary centre. J Assoc Physicians India. 2003;51:16-19.
22. Graham G. Acute Coronary Syndromes in Women: Recent Treatment Trends and Outcomes. Clin Med Insights Cardiol. 2016;10:1-10.
Views & Downloads
Abstract views: 268   
PDF downloads: 233   
How to Cite
Indriani, S., Adiarto, S., Andriantoro, H., Sunu, I., Siddiq, T., & Dakota, I. (2021). The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients. Indonesian Journal of Cardiology, 42(1).