Cardiogenic embolism of the upper extremity

Arterial embolism of the upper extremity is not as rare and especially not as benign in all instances as was considered in the past. Postembolic ischemic changes or frank gangrene of fingers or hand may occur in a substantial percentage of patients. This paper will attempt to update the current concepts of this problem. The clinical data and the methods for evaluation of the degree of viability of the hand or forearm will be reviewed. Arteriography is recommended more liberally than in the past. Arterial embolectomy usually performed under local anesthesia is widely applicable in view of the simplicity, safety and effectiveness of the balloon catheter technique. The overall results based on a compilation from six reports indicate that complete circulatory restoration occurred in 55% and salvage without a return of wrist pulses in 24%. Gangrene occurred in 9.3% and mortality in 11.8%. In general, mortality following embolectomy is primarily related to the gravity of the cardiopathy and least to the surgical procedure.