Management of acute brachial artery occlusion due to trauma or emboli

Out of 37 patients requiring emergency surgery for upper limb ischaemia, 9 were due to spontaneous embolus, 7 to arterial laceration and 21 followed cardiac catheterization. Eleven of the initial operations (30 per cent) failed to relieve ischaemic symptoms though 6 were corrected by further operations. Success at the initial operation was associated with (i) repair with end-to-end anastomosis after resection, saphenous vein bypass or interposition graft, or generous vein patch, (ii) exposure of the radial/ulnar bifurcation, (iii) instillation of heparinized saline locally or (iv) restoration of the radial pulse at the end of the operation. In the cases studied in whom all the above recommendations were followed, the operation was entirely successful and all patients have a radial pulse and are currently symptom free.