[Surgery for acute arterial emboli to the arm]

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Interventional Radiology

Context:

• Acute arterial embolism of the upper extremity is a critical condition requiring prompt management.
• Cardiac origin is the most common cause of upper extremity arterial emboli.
• Surgical intervention using Fogarty catheters is a primary treatment modality.

Purpose:

• To evaluate the efficacy and outcomes of Fogarty catheter embolectomy for acute upper extremity arterial occlusions.
• To determine the optimal timing for surgical intervention in cases of acute arterial embolism.
• To assess the necessity of routine arteriography prior to surgical exploration.

Summary:

• A 5-year study analyzed 20 emboli and 2 thrombi removals from 18 patients (aged 60-90) using Fogarty catheters under local anesthesia.
• The majority of emboli (90%) were cardiac in origin, affecting brachial (70%) and axillary (25%) arteries.
• Surgery achieved a 95% success rate, with limb necrosis occurring in a patient operated on 1 week post-symptom onset.

Impact:

• Early surgical exploration is advocated for acute arterial embolism of the upper extremity.
• Ischemic changes can be reversible even beyond 24 hours from symptom onset.
• Routine arteriography is not essential before surgical exploration for these cases.