[Revascularization delay and complications in acute upper limb ischemia].

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Neurology

Background:

• Acute upper limb ischemia presents a critical medical and surgical challenge.
• Limited data exists on revascularization outcomes for acute upper limb ischemia, leaving optimal timing poorly defined.
• This study investigates the impact of revascularization delay on surgical outcomes.

Purpose of the Study:

• To evaluate the surgical results of acute upper limb ischemia in relation to the delay before revascularization.
• To compare limb salvage and neurological sequelae rates based on a 12-hour revascularization time threshold.

Main Methods:

• Retrospective analysis of 138 patients undergoing surgery for acute upper limb ischemia between 2008 and 2016.
• Exclusion of cases with thrombotic, traumatic, or iatrogenic causes.
• Patients were categorized into two groups: operated before 12 hours and after 12 hours, with outcomes compared statistically.

Main Results:

• The overall limb salvage rate was 86.9%, with no significant difference between early (<12 hours) and late (≥12 hours) revascularization (86.8% vs. 87%, P=0.258).
• Neurological sequelae occurred in 31.8% of patients overall.
• A significantly higher rate of neurological sequelae was observed in patients operated after 12 hours (51.6%) compared to those operated before 12 hours (15.7%, P=0.012).

Conclusions:

• Revascularization for acute embolic upper limb ischemia can yield good results even with delays.
• Surgical delay beyond 12 hours did not significantly increase amputation rates.
• Delayed revascularization (≥12 hours) is associated with a higher incidence of neurological sequelae.