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Arterial emboli of the upper extremity: a persisting problem
Insights
Emboli of the upper extremities (UEE) often stem from cardiac disease. Prompt embolectomy within 10 hours led to good outcomes in most patients, demonstrating effective treatment for UEE.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Embolic Disease
Background:
- Emboli of the upper extremities (UEE) represent a significant clinical challenge.
- Understanding the etiology, presentation, and management outcomes of UEE is crucial for patient care.
Purpose of the Study:
- To analyze the management and outcomes of 154 cases of upper extremity emboli (UEE) over an 11-year period.
- To identify patient demographics, obstruction levels, associated conditions, and treatment strategies for UEE.
Main Methods:
- Retrospective review of 154 UEE cases managed between 1969 and 1980.
- Data collection included patient demographics, obstruction site, cardiac disease prevalence, ischemia severity, treatment modalities, and outcomes.
Main Results:
- 151 patients (66% female, mean age 68.9) experienced 154 UEE, predominantly affecting the brachial artery (74 cases).
- Cardiac disease was a common comorbidity (119 cases). Severe ischemia occurred in 30% of cases.
- 106 patients underwent surgery within 10 hours, with 140 primary embolectomies being the main treatment. Reoperation was infrequent (7%).
Conclusions:
- Prompt surgical intervention, primarily embolectomy, yields favorable results in managing upper extremity emboli.
- Cardiac disease is a major underlying factor, necessitating comprehensive patient evaluation.
- Effective management of UEE leads to clinical improvement and restoration of arterial patency in the majority of patients.
Abstract:
From 1969 to 1980, 154 emboli of the upper extremities (UEE) were managed in our institution. They occurred in 151 patients, 66 males (44%) and 85 females (56%) aged ranged from 23 to 87 years (mean 68.9). Obstruction level was in the subclavian artery (12 cases), the axillary artery (46), the brachial artery (74 cases), the radial or ulnar artery (22 cases). Cardiac disease was present in 119 cases. Ischemia was severe in 47 cases (30%), and partial in 104 (67%). Peripheral gangrene was already present in 2 cases. 106 patients were operated on within 10 hours after the occurrence of UEE (69%). Associated systemic emboli was noted in 10 cases. The treatment consisted in 140 primary embolectomies and in 11 cases of conservative therapy (heparin 10, thrombolysis 1). Reoperation was done in 11 patients (7%) because of recurrence of UEE and in 4 cases (2%) for post-operative thrombosis. Results were good in 128 patients with clinical improvement and arterial patency.