Upper limb ischemia resulting from arterial thromboembolism.

Area of Science:

• Vascular Surgery
• Arterial Thrombosis
• Ischemia

Background:

• Acute upper limb ischemia is frequently caused by trauma or embolic arterial occlusion.
• Primary atherosclerotic thrombosis is an infrequent but significant cause of upper limb ischemia.
• Concerns regarding the incidence, recognition, and treatment of primary atherosclerotic thrombosis prompted this review.

Purpose of the Study:

• To review clinical experience with acute upper limb ischemia.
• To determine the incidence of primary atherosclerotic thrombosis in acute upper limb ischemia.
• To evaluate the role of arteriography in diagnosing and treating acute upper limb ischemia.

Main Methods:

• Retrospective review of 36 patients with acute ischemia of the upper limb.
• Analysis of causes including embolic occlusion, iatrogenic thrombosis, and primary arterial thrombosis.
• Assessment of the utility of arteriography and intraoperative arteriograms.

Main Results:

• Out of 36 patients, 17 (47.2%) had embolic occlusion, 9 (25%) iatrogenic brachial artery thrombosis, and 10 (27.8%) primary arterial thrombosis.
• Primary atherosclerotic thrombosis accounted for 6 of 36 (16.7%) cases, and 8 (22.2%) cases involved noncardiac emboli or primary atherosclerotic thrombosis.
• Atherosclerotic thrombosis, including trauma-associated cases, represented 10 of 36 (27.8%) ischemic limbs.

Conclusions:

• An aggressive diagnostic approach, including arteriography, is warranted for undiagnosed acute upper limb ischemia.
• Routine intraoperative arteriograms may improve operative results in patients with iatrogenic brachial artery thrombosis.
• Primary atherosclerotic thrombosis is a notable cause of acute upper limb ischemia requiring timely intervention.