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Upper limb embolus: a timely diagnosis.

M G Davies1, K O'Malley, M Feeley

  • 1Department of Vascular Surgery, St. James's Hospital Dublin, Ireland.

Annals of Vascular Surgery
|January 1, 1991
PubMed
Summary
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Prompt surgical intervention for upper limb embolic occlusion yields excellent limb salvage rates. Delays beyond 24 hours significantly increase the risk of limb loss, emphasizing the need for timely treatment.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Medicine
  • Emergency Medicine

Background:

  • Embolic occlusion of upper limb vessels is a critical condition requiring prompt diagnosis and management.
  • Cardiac sources are the most common cause of upper limb emboli, followed by peripheral aneurysms.

Purpose of the Study:

  • To evaluate the surgical outcomes and long-term patency rates for patients treated for upper limb embolic occlusion.
  • To determine the impact of presentation time on treatment success and limb salvage.

Main Methods:

  • A retrospective review of 36 patients surgically treated for upper limb embolic occlusion over a ten-year period.
  • Surgical interventions included brachial embolectomy in all cases and resection of peripheral aneurysms where indicated.
  • Data collected included embolus source, surgical procedure, patency rates, and hospital mortality and morbidity.

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Main Results:

  • A high 5-year patency rate of 94% was achieved following surgical intervention.
  • Hospital mortality was 3% and morbidity was 10%.
  • Limb loss occurred in three patients who presented after 36 hours, highlighting the critical time window for intervention.

Conclusions:

  • Surgical treatment for upper limb embolic occlusion is effective, with prompt intervention (<24 hours) leading to the best outcomes.
  • Early recognition and surgical management are crucial to prevent complications such as ischemic contracture and amputation.
  • Delayed presentation significantly compromises limb salvage, underscoring the importance of rapid surgical treatment.