[Clinical management of revascularization in upper limb ischemia]

To investigate the etiology, diagnosis, revascularization of upper limb ischemia and the complications.

From March 2003 to February 2008, 72 cases of upper limb ischemia were treated. There were 44 males and 28 females, aged 19-90 years old (median 63 years old). The duration of the disease was 1 hour to 2 years. All cases had symptoms of limb ischemia such as paleness, coldness, paralysis. According to individual condition, 72 patients accepted revascularizations including thromboembolectomy, reconstruction after traumatic injuries, pseudoaneurysm excision and angioplasty, balloon dilatation and stent implant, arterial repair, patch, vascular prosthesis or vein bypass/transplantation, and ligation or coarctation of fistula.

Sixty patients (83.3%) recovered well after operation. Re-occlusion following thromboembolectomy was found in 6 patients (8.3%). And there were 4 patients (5.6%) with limbs disturbance and muscles contracture and 2 patients (2.8%) with compartment syndrome in this series. The affected limb had to be amputated in 2 patients (2.8%). And 1 patient (1.4%) died of cerebral hemorrhage because of anticoagulation 3 days after operation. All patients were followed up 1-6 years (mean 52 months) after operation. Four patients recurred and got improved after retreatments. The others got a good result with normal skin color and temperature, restoration of the radial and ulnar pulses, normal saturation of blood oxygen of finger tip (> 90%) and patent blood flow of affected arteries was shown by color Doppler ultrasound.

The study indicates that identifying the biology of upper limb ischemia before operation and active revascularizations consistent with different causes are the key to treat the upper limb ischemia.