Outcomes of Upper-Extremity Revascularization Following Acute Limb Ischemia

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Clinical Outcomes Research

Background:

• Acute limb ischemia (ALI) is a critical vascular condition requiring immediate diagnosis and intervention.
• Upper-extremity ALI presents unique challenges in incidence, clinical manifestation, and patient outcomes.

Purpose of the Study:

• To determine the incidence, clinical presentation, and outcomes of upper-extremity ALI.
• To analyze the influence of patient risk factors on ALI outcomes.
• To evaluate the efficacy and risks of prophylactic fasciotomy in upper-extremity ALI.

Main Methods:

• Retrospective review of 366 patients undergoing upper-extremity revascularization for ALI (2003-2023).
• Inclusion criteria: ischemia duration under 14 days.
• Data analysis included demographics, risk factors, ischemia duration, presentation, etiology, hospitalization, and complications.

Main Results:

• The average patient age was 65 years, with 69.7% females. Common causes were embolism (21.5%) and iatrogenic injury (29.3%).
• Brachial artery occlusion was most frequent (89%). Median ischemia time was 12 hours.
• Complications occurred in 21.9% of patients. Prophylactic fasciotomy (3%) showed no reduced ischemia time and was linked to more complications.

Conclusions:

• Upper-extremity ALI revascularization is associated with significant complication rates.
• Ischemia duration correlates with symptom severity but not necessarily complications or hospital stay.
• Routine prophylactic fasciotomy in upper-extremity ALI is questionable due to potential increased risks and lack of demonstrated benefit.