Clinical experience of upper limb ischemia: a retrospective study

Background: Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. This study presents a review of the epidemiology, aetiology, and clinical characteristics of upper limb ischemia.Methods: The records of 70 patients with upper limb ischemia who underwent treatment from were retrospectively reviewed.Results: A total of 44 patients were diagnosed by CT. Other diagnostic methods and tools used were conventional angiography and duplex ultrasound. Four cases were diagnosed solely on the basis of a medical history and physical examination. A total of 56 surgeries were performed. Rest of the 14 patients went under conservative therapy. The operations included embolectomy and thrombectomy using a Fogarty balloon catheter (n=32), bypass surgery using the great saphenous vein (n=10), percutaneous catheter-directed thrombolysis (n=8), and primary repair (n=4). Patients with Raynaud’s phenomenon or Burger’s disease were either treated with medication only (n=14) or with sympathectomy (n=2).Conclusions: The duration of symptoms in cases of upper limb ischemia may vary from two hours to a year, depending on the aetiology and severity of the illness. Many debates have addressed whether the time gap between the onset of symptoms and treatment predicts long-term arm function.

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Upper Limb Ischemia: 20 Years Experience from a Single Center

Vascular ◽

10.1258/rsmvasc.13.2.84 ◽

2005 ◽

Vol 13 (2) ◽

pp. 84-91 ◽

Cited By ~ 32

Author(s):

Jean Deguara ◽

Tahir Ali ◽

Bijan Modarai ◽

Kevin G. Burnand

Keyword(s):

Upper Limb ◽

Primary Repair ◽

Limb Ischemia ◽

Subclavian Steal Syndrome ◽

Arm Amputation ◽

Locoregional Anesthesia ◽

Vein Bypass ◽

Almost All ◽

Revascularization Procedures ◽

Steal Syndrome

The objective of this study was to review a single center's experience of upper limb revascularization over 20 years. All patients undergoing operative or endovascular upper limb revascularization between June 1983 and July 2003 were identified. One hundred eighty-four upper limb revascularization procedures were carried out on 172 patients. Sixty-one patients had a thromboembolic event (35%), 53 patients presented with a traumatic vascular injury (31%), and 29 patients had symptoms of chronic atherosclerotic upper limb ischemia (17%). Fifteen patients had subclavian steal syndrome, eight patients had thoracic outlet compression, and six patients had iatrogenic injuries of the upper limb arteries. Fifty-five thromboembolectomies were performed, 37 under locoregional anesthesia. Ten patients (18.2%) died from cardiopulmonary causes following embolectomy. Fifteen reversed saphenous vein bypass grafts were performed for traumatic damage. Twenty-seven patients had a primary repair, and five required a vein patch. One patient subsequently had an arm amputation, and two patients died. Twelve patients presenting with chronic arm ischemia had a subclavian angioplasty, 12 patients had a proximal bypass, and in 5 patients, stenoses were stented. The mortality in this group was 6.9% (2 of 29). The mortality for upper limb revascularization was 8.7%. Almost all deaths occurred after upper limb embolectomy, and the mortality of this procedure was similar to that of lower limb embolectomy. Deaths were the result of cardiac comorbidity, and this should be actively sought and treated if outcomes are to improve.

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Upper-Extremity Arteries

Interventional Radiology ◽

10.1093/med/9780190276249.003.0019 ◽

2018 ◽

pp. 219-236

Author(s):

Adam Zybulewski ◽

Ilya Livshitz ◽

Bhumika Patel ◽

Aaron Fischman

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Treatment Options ◽

Clinical Manifestations ◽

Limb Ischemia ◽

Arterial Injury ◽

Arterial Access ◽

Imaging Characteristics ◽

Ischemic Syndrome

This chapter evaluates the spectrum of pathologic diseases that affect the upper-extremity arteries, their clinical manifestations, imaging characteristics, and treatment options. We review the role of surgical and endovascular intervention for the treatment of acute upper limb ischemia (AULI) and chronic upper limb ischemia (CULI), the clinical and imaging findings associated with Raynaud’s phenomenon, hypothenar hammer syndrome, distal hypoperfusion ischemic syndrome (DHIS), thromboangittis obliterans (TOA), thoracic outlet syndrome (TOS), giant cell arteritis, Bechet’s disease, radiation arteritis, and traumatic arterial injury, including compartment syndrome and pseudoanuerysm formation. Finally, the evolution of upper-extremity arterial access and use of transradial access (TRA), including benefits and risks, technique, and complications, are discussed.

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Femoral Balloon-Oriented Puncture for True Lumen Reentry in the Common Femoral Artery After Subintimal Retrograde Recanalization of Superficial Femoral Artery Ostial Occlusion: The FORLEE Technique

Journal of Endovascular Therapy ◽

10.1177/1526602819849722 ◽

2019 ◽

Vol 26 (4) ◽

pp. 490-495 ◽

Cited By ~ 1

Author(s):

Gabriele Testi ◽

Tanja Ceccacci ◽

Mauro Cevolani ◽

Francesco Giacchi ◽

Fabio Tarantino ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Balloon Catheter ◽

Duplex Ultrasound ◽

Cost Effective ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Anterior Tibial Artery ◽

True Lumen ◽

The Common

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

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The Role of Duplex Ultrasound in the Detection of Upper Extremity Artery Pathology, and Post Endovascular Complications

Journal for Vascular Ultrasound ◽

10.1177/1544316718763392 ◽

2018 ◽

Vol 42 (1) ◽

pp. 26-29

Author(s):

Jason Roberts ◽

Vaqar Ali ◽

Mian Ahmed Hasan

Keyword(s):

Upper Extremity ◽

Fibromuscular Dysplasia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Arterial Disease ◽

Upper Extremities ◽

Peripheral Arterial ◽

The Relationship ◽

Abnormal Pathology

Upper extremity pathology is uncommon and generally involves the brachial artery in about 12% of the cases. Of chronic upper limb ischemia, trauma, fibromuscular dysplasia, giant cell arteritis, and atherosclerosis are among the most reported cases. After a thorough review of the literature, there is agreement with duplex ultrasound sensitivity and specificity for predicting >70% stenosis in the subclavian arteries with a sensitivity of >82% and specificity of >90%. This article not only correlates the relationship between duplex ultrasound and severe peripheral arterial disease, but it also proves with 100% accuracy the ability to detect latent and abnormal pathology of the upper extremities post endovascular intervention.

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Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia

CardioVascular and Interventional Radiology ◽

10.1007/s00270-017-1599-z ◽

2017 ◽

Vol 40 (7) ◽

pp. 978-986 ◽

Cited By ~ 3

Author(s):

Tatsuo Ueda ◽

Satoru Murata ◽

Izumi Miki ◽

Daisuke Yasui ◽

Fumie Sugihara ◽

...

Keyword(s):

Endovascular Treatment ◽

Upper Limb ◽

Treatment Strategy ◽

Limb Ischemia ◽

Percutaneous Aspiration ◽

Catheter Directed Thrombolysis

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Catheter-Directed Thrombolysis for Acute Upper Limb Ischemia in the Neonate

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.10.027 ◽

2018 ◽

Vol 29 (5) ◽

pp. 742-744 ◽

Cited By ~ 1

Author(s):

Keith Pereira ◽

Russell M. Salamo ◽

Brandon M. Tallman ◽

Wambui Waruingi ◽

Kirubahara Vaheesan

Keyword(s):

Upper Limb ◽

Limb Ischemia ◽

Catheter Directed Thrombolysis

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SURGICAL TREATMENT OF PATIENTS WITH DISLOCATION OF HEAD OF THE ARM AND ROTATIONAL CONTRACTURE OF THE FOREARM WITH BIRTH PALSY OF THE UPPER EXTREMITY

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors2132-38 ◽

2014 ◽

Vol 2 (1) ◽

pp. 32-38

Author(s):

Nikolai Alexandrovich Ovsyankin ◽

Natalia Anatolievna Naumochkina

Keyword(s):

Surgical Treatment ◽

Upper Extremity ◽

Upper Limb ◽

Diagnostic Methods ◽

Pediatric Orthopedics ◽

Actual Problem ◽

Surgical Methods ◽

High Incidence ◽

Birth Palsy ◽

Methods Of Treatment

Introduction. The obstetrical upper limb paralysis and its sequelae are an actual problem of pediatric orthopedics and traumatology. Relevance of the problem is due to high incidence of this disease and increase of child disability. Purpose. To present the method of treating patients with a dislocated radius head and forearm rotation contracture in birth paralysis of the upper extremity. ^Materials and Methods. This article presents the clinical material on the survey in the Institute and the surgical treatment of 12 patients aged from three to 15 years with the pathology of the elbow and forearm, developed after the obstetrical upper limb paralysis. Results. We present the clinical picture, diagnostic methods, indications to surgical treatment, as well as new and effective methods of performing the proximal radioulnar joint arthrodesis in young children with obstetrical paralysis of the upper extremity. The use of surgical methods of treatment in such patients has improved the function of the arm and self-care in 95 per cent of cases, reduced their disability and increased their choice for occupation activities.

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Current Treatment Options in Acute Limb Ischemia

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0998-4204 ◽

2019 ◽

Vol 192 (04) ◽

pp. 319-326

Author(s):

Friederika Fluck ◽

Anne Marie Augustin ◽

Thorsten Bley ◽

Ralph Kickuth

Keyword(s):

Treatment Time ◽

Treatment Options ◽

Limb Ischemia ◽

Current Treatment ◽

Acute Ischemia ◽

Symptom Duration ◽

Acute Limb Ischemia ◽

Arterial Embolism ◽

Duration Of Symptoms ◽

Catheter Directed Thrombolysis

Background Acute limb ischemia represents a clinical emergency with eventual limb loss and life-threatening consequences. It is characterized by a sudden decrease in limb perfusion. Acute ischemia is defined as a duration of symptoms for less than 14 days. Aging of the population increases the prevalence of acute limb ischemia. The two principal etiologies are arterial embolism and in situ thrombosis of an atherosclerotic artery. Immediate diagnosis, accurate assessment and urgent intervention when needed are crucial to save the limb and to prevent a major amputation. Delay in diagnosis and therapy may lead to irreversible ischemic damage. Method To assess the current treatment options in acute limb ischemia, this review is based on a selective literature search in PubMed representing the current state of research. Results and Conclusion Patients with acute limb ischemia should receive immediate anticoagulation. Treatment depends on the classification based on the degree of ischemia and limb viability. Especially acute (< 14 days symptom duration) Rutherford Categories IIa and IIb with marginally and immediately threatened limbs require definitive therapeutic intervention and are salvageable, if promptly revascularized. The current literature suggests that open surgical revascularization is more time effective then catheter-directed thrombolysis. However, with the advent of thrombolytic delivery systems and mechanical thrombectomy devices, treatment time can be minimized and successful utilization in patients with Category IIb (Rutherford Classification for Acute Limb Ischemia) has been reported with promising limb-salvage and survival rates. Large randomized studies are still missing, and guidelines suggest choosing the method of revascularization depending on anatomic location, etiology, and local practice patterns, with the time to restore the blood flow being an important factor to consider. Key points: Citation Format

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Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽

10.1024/0301-1526.37.4.327 ◽

2008 ◽

Vol 37 (4) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Koutouzis ◽

Sfyroeras ◽

Moulakakis ◽

Kontaras ◽

Nikolaou ◽

...

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Cardiac Troponin ◽

Cardiac Involvement ◽

Troponin I ◽

Limb Ischemia ◽

Elevated Troponin ◽

Troponin Elevation ◽

Lower Limb Ischemia ◽

Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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