COMPARATIVE ANALYSIS OF ACUTE UPPER AND LOWER EXTREMITY ISCHEMIA DUE TO ARTERIAL EMBOLISM

To perform a comparative analysis of the etiology, clinical course, treatment strategy, and outcomes of acute ischemia of the upper extremity (AUEI) and lower extremity (ALEI) caused by arterial embolism.

The study included 1,843 patients with embolic arterial occlusion admitted as emergencies. The study group (n=748) comprised patients with AUEI, and the comparison group (n=1,095) included patients with ALEI. A retrospective analysis was performed for the period 1991-2009 and a prospective analysis for 2010-2022, covering demographic parameters, distribution of cardioembolic sources, clinical features of acute ischemia, surgical management, postoperative complications, and in-hospital mortality.

Patients with AUEI were significantly older (73.1 vs. 69.1 years, p<0.05) and more frequently had non-valvular atrial fibrillation (73.7% vs. 62.5%, p<0.001). AUEI was characterized by distal occlusion (brachial artery in 63.1% of cases), whereas ALEI showed a predominantly proximal distribution (aortoiliac-femoral segment in 73.8%). The clinical course of AUEI was more favorable: grade I ischemia was observed in 55.6% of patients (vs. 20.5% in ALEI, p<0.001), and irreversible ischemia (IIIB) occurred in only 0.9% of cases (vs. 9.4% in ALEI, p<0.001). In-hospital mortality in the AUEI group was 2.5-fold lower (5.9% vs. 14.7%, p<0.001), attributable to a lower incidence of severe limb-specific complications, including reperfusion injury (2.1% vs. 18.5%, p<0.001) and wound infection (0.5% vs. 8.6%, p<0.001).

Acute upper and lower extremity ischemia due to arterial embolism represent two distinct clinical syndromes. AUEI is characterized by a more favorable clinical course, superior collateral compensation, and a smaller volume of ischemic tissue, which translates into substantially lower mortality compared with ALEI.