Upper limb emboli. A review of 55 patients managed surgically

During an eleven years period 1976-1986, 55 patients with emboli to the upper limb were managed at St. Laurence's Hospital. The presentation was classical for acute limb ischaemia in the majority while 27% presented 48 hours or more after the onset of symptoms. Four patients presented with gangrene. In 41 patients a source of embolus was readily identified: atrial fibrillation (33), recent myocardial infarct (5), subclavian artery aneurysm (2), left atrial myxoma (1). In the remaining 14 patients the source of the embolus was not initially apparent but investigation by echocardiography, 24 hour Holter monitoring and coagulation studies suggested a source in eight. Embolectomy was performed in 51 patients and amputation as a primary procedure in two. The patients with subclavian artery aneurysms were not treated surgically. A normal circulation was restored both clinically and angiographically in 43 patients, four of whom later died from myocardial infarction. Four of the remaining eight patients had residual arm claudication, three required amputation and one had an ischaemic contracture. The failure to restore a normal circulation was uniformly associated with delayed presentation or failure to adequately anticoagulate the patient with heparin.