Arterial emboli to the arm

A review of 46 episodes of arterial emboli to the arm in 44 patients is presented. Two-thirds of cases were of cardiac origin whereas subclavian artery abnormality was responsible for 14%. Thirty-six per cent had axillary occlusion, 52% had a brachial lesion, and the lesion was distal to the elbow in 11%. Of the 36 patients treated surgically, 33 retained a viable arm with a palpable radial pulse in 26. Of the ten patients with 'failed first embolectomy', six technical failures were revised successfully, retaining a viable hand in all of them. The other four failures had evidence of organized intraluminal thrombus; one had been induced by anti-thrombin III deficiency. Three of this latter group lost limbs. Because delay leads to irreversible ischaemic changes, there seems to be an understandable bias in favour of early surgical exploration in equivocal cases.