DOI: http://dx.doi.org/10.18203/2349-2902.isj20201869

Clinical experience of upper limb ischemia: a retrospective study

Jitesh Tolia, Arvind Bhatt

Abstract


Background: Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. This study presents a review of the epidemiology, aetiology, and clinical characteristics of upper limb ischemia.

Methods: The records of 70 patients with upper limb ischemia who underwent treatment from were retrospectively reviewed.

Results: A total of 44 patients were diagnosed by CT. Other diagnostic methods and tools used were conventional angiography and duplex ultrasound. Four cases were diagnosed solely on the basis of a medical history and physical examination. A total of 56 surgeries were performed. Rest of the 14 patients went under conservative therapy. The operations included embolectomy and thrombectomy using a Fogarty balloon catheter (n=32), bypass surgery using the great saphenous vein (n=10), percutaneous catheter-directed thrombolysis (n=8), and primary repair (n=4). Patients with Raynaud’s phenomenon or Burger’s disease were either treated with medication only (n=14) or with sympathectomy (n=2).

Conclusions: The duration of symptoms in cases of upper limb ischemia may vary from two hours to a year, depending on the aetiology and severity of the illness. Many debates have addressed whether the time gap between the onset of symptoms and treatment predicts long-term arm function.


Keywords


Arterial disorders, Embolectomy, Ischemia, Upper limb

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References


Barkhof F, Jäger R, Thurnher M, Rovira A. Multiple sclerosis and variants. In: Clinical Neuroradiology: The ESNR Textbook. Springer International Publishing; 2018: 1-41.

Turner E, Loh A, Howard A. A conservative approach to acute upper limb ischaemia. Vascular Dis Management. 2010;7:E219-E22.

Kamel I, Barnette R. Positioning patients for spine surgery: avoiding uncommon position-related complications. World J Orthopedics. 2014;5:425.

Richardson JD, Vitale GC, Flint LM. Penetrating arterial trauma: analysis of missed vascular injuries. Arch Surg. 1987;122:678-83.

Fabian TC, Patton Jr JH, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg. 1996;223:513.

von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GS, Heng M, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386:1299-310.

Lance JW, McLeod JG. A physiological approach to clinical neurology. 3rd edn. Butterworth-Heinemann; 2013.

Bae M, Chung SW, Lee CW, Choi J, Song S, Kim S. Upper limb ischemia: clinical experiences of acute and chronic upper limb ischemia in a single center. Korean J Thorac Cardiovasc Surg. 2015;48:246-51.

Bannas P, François CJ, Reeder SB. Magnetic resonance angiography of the upper extremity. Magnet Resonance Imag Clin. 2015;23:479-93.

Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease: a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines. J Am Coll Cardiol. 2006;47:e1-192.

Spinelli F, Benedetto F, Passari G, La Spada M, Carella G, Stilo F, et al. Bypass surgery for the treatment of upper limb chronic ischaemia. Eur J Vasc Endovasc Surg. 2010;39:165-70.

Licht P, Balezantis T, Wolff B, Baudier J-F, Røder O. Long-term outcome following thrombembolectomy in the upper extremity. Eur J Vasc Endovasc Surg. 2004;28:508-12.

Brunkwall J, Bergqvist D, Bergentz SE. Long-term results of arterial reconstruction of the upper extremity. Eur J Vasc Surg. 1994;8:47-51.

Crosbie TW. Psychological aspects of patients with Fabry disease. Dissertation. Pacific Graduate School of Psychology; 2006.