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Natural History of Acute Nontraumatic Upper Limb Ischemia
Fuad Abbas, BS, Diane Jo, MA, Mazen Al-Malak, MD, Riley Marlar, BS, Ying Ku, BS, Rommy Obeid, BS, Fiona Fragomen, BS, Antonio Rampazzo, MD, PhD, Bahar Bassiri-Gharb, MD, PhD
Cleveland Clinic Foundation
2024-02-01
Presenter: Fuad Abbas, BS
Affidavit:
I certify that the content within is the authors' original work and has not been previously published or presented.
Director Name: Bahar Bassiri-Gharb
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Purpose: Acute upper limb ischemia (AULI) is a surgical emergency. We aimed to characterize the etiology, treatment, and outcomes of AULI.
Methods: An IRB-approved retrospective review of patients who underwent upper extremity revascularization for non-traumatic AULI from 2009 to 2022 was performed. Demographics, comorbidities, presentation, etiology, ischemia time, vessel involved, complications and outcomes were reviewed.
Results: Three hundred and fifty-five patients were included (30.7% males and 69.3% females, averaging 70.5 years). The most relevant comorbidities included: hypertension (74.3%), atrial fibrillation (32.7%), and coronary artery disease (31.8%). The primary occluded artery was the brachial (78.9%), followed by the radial (34.1%), ulnar (25.4%), axillary (14.6%), and subclavian (5.4%). Etiologies included iatrogenic vessel injury (44.2%), idiopathic causes (24.5%), atrial fibrillation-related embolism (19.7%), and other embolic causes (11.6%). Mean ischemia time was 30.8 hours, and mean revascularization time was 2.8 hours. Treatment included surgical thromboembolectomy (92.4%), patch angioplasty (3.9%), bypass (1.4%), and percutaneous thrombolysis (0.8%). Nine patients (2.5%) developed compartment syndrome (CS) and underwent fasciotomy. Eleven patients received prophylactic fasciotomy (3.1%). Complications included rethrombosis (6.5%), hematoma (5.9%), excessive postoperative bleeding (1.7%), tissue necrosis (1.4%), wound dehiscence (0.56%), and infection (0.56%). Limb survival rate was 97.5%, with 9 limbs lost. Fasciotomy correlated with a significantly higher limb loss rate (p<0.0001). Inpatient mortalities totaled 25 (7.0%), with fasciotomy patients experiencing significantly higher mortality (p<0.0001). Causes of inpatient mortality were unrelated to upper limb ischemia.
Conclusion: Emergency upper extremity revascularization results in high limb salvage and is rarely complicated by compartment syndrome.
