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Management of acute nontraumatic upper limb ischemia
M Baguneid1, D Dodd, P Fulford
1Department of Vascular Surgery, Manchester Royal Infirmary, England.
Angiology
|September 25, 1999
Summary
Intraarterial thrombolysis effectively treats acute nontraumatic upper limb ischemia. This study found it to be a successful first-line option for selected patients, with no recurrence of ischemia at follow-up.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Acute nontraumatic upper limb ischemia is a rare but serious condition.
- Management strategies vary, with a need to evaluate the efficacy of different interventions.
Purpose of the Study:
- To assess the role and effectiveness of intraarterial thrombolysis in managing acute nontraumatic upper limb ischemia.
- To compare outcomes with other treatment modalities.
Main Methods:
- Retrospective review of 21 patients with acute nontraumatic upper limb ischemia.
- Analysis of diagnostic angiography findings and treatment outcomes.
- Evaluation of intraarterial thrombolysis, surgical intervention, and conservative management.
Main Results:
- Intraarterial thrombolysis was attempted in 12 patients with a 50% complete lysis rate.
- Technical failures (3) and unsuccessful thrombolysis (2) required further intervention.
- Surgical intervention and conservative heparin therapy also yielded varied outcomes.
- No recurrence of ischemia was observed at a median 18-month follow-up.
Conclusions:
- Intraarterial thrombolysis is an effective first-line treatment for selected cases of acute nontraumatic upper limb ischemia.
- Angiography is crucial for diagnosis, while ECG and ECHO had limited utility.
- Long-term anticoagulation with warfarin was prescribed to all patients.