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Atraumatic Acute Upper Limb Ischemia

A Series of 64 Patients in a Middle East Tertiary Vascular Center and Literature Review

Denis Evoy, MCh, FRCSI

Department of Vascular and Endovascular Surgery, St James's Hospital, Trinity College, Dublin, Ireland

Ahmed Saad Eldin, MD

Maged Eldeeb, MD

Nabil Elmehairy, MD, FRCS

Dublin, Ireland and Cairo, Egypt

This paper documents the various causes of upper limb ischemia in a series of 64 Egyptian patients presenting to a tertiary referral center over a 4-year period and offers a diagnostic dissertation and review of the pertinent literature. Atraumatic upper limb ischemia is an uncommon entity. It has a broad etiology with diverse management pathways. Nineteen patients presented with severe and immediate limb-threat ening ischemia. These patients underwent immediate surgical exploration: an embolus was diagnosed in 15 and thrombosis in 4. Twenty-eight patients presented with ischemia of lesser severity, allowing preoperative angiography. Of these 28 patients, 6 had an embolus, 14 had thrombosis, 4 had thoracic outlet syndrome, the remainder had miscellaneous causes. Fifteen patients had upper limb ischemia secondary to arteritis, and 2 patients with dissection of the ascending thoracic aorta presented with upper limb ischemia. Forty-seven patients underwent a surgical procedure, with a morbidity rate of 21% and mortality rate of 19%. Patients presenting with upper limb ischemia tend to have significant co-existing disease. Management of upper limb ischemia requires preoperative and/or peroperative angiography with careful application of vascular surgical expertise.

Vascular and Endovascular Surgery, Vol. 35, No. 3, 181-197 (2001)
DOI: 10.1177/153857440103500305


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