Upper extremity ischemia (UEI) is an uncommon condition that can lead to permanent disability. There is a limited understanding of the etiology, management, and outcomes of the disease.
Methods:
We retrospectively reviewed the charts of all patients who were diagnosed with “embolism and/or thrombosis of arteries of upper extremity” at our institution from January 2005 to December 2013.
Results:
Patients diagnosed with embolisms were older (P < .001), more likely to undergo thromboembolectomy (P < .001), had higher rates of hypertension (P = .001), and had longer lengths of hospital stay (P = .002). There were no significant differences in complications or mortality at 30 days and up to 1 year.
Conclusion:
At our center, embolism was found to be the most common etiology for UEI followed by thrombosis and stenosis. Patients presented with embolism were older, were more likely to undergo thromboembolectomy, and had higher rates of hypertension and longer hospital stays.
HigashimoriAKawaradaOYokoiY. Aspiration thrombectomy for acute foot and hand ischemia. Catheter Cardiovasc Interv. 2011;78(6):953–957.
2.
KimSKKwakHSChungGHHanYM. Acute upper limb ischemia due to cardiac origin thromboembolism: the usefulness of percutaneous aspiration thromboembolectomy via a transbrachial approach. Korean J Radiol. 2011;12(5):595–601.
3.
MiyayamaSYamashiroMShibataY. Thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity. Jpn J Radiol. 2012;30(2):180–184.
4.
NorgrenLHiattWRDormandyJA. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–S67.
5.
TurnerEJLohAHowardA. Systematic review of the operative and non-operative management of acute upper limb ischemia. J Vasc Nurs. 2012;30(3):71–76.
6.
La MarcaGLa BarberaGRinaudoGRicevutoGMartinoA. Acute upper limb ischemia of embolic origin: 682 cases. Ital J Vasc Endovasc. 2005;12(2):65.
7.
CarrafielloGLaganaDManginiM. Percutaneous treatment of traumatic upper-extremity arterial injuries: a single-center experience. J Vasc Interv Radiol. 2011;22(1):34–39.
8.
MuftyHJanssenASchepersS. Dealing with symptomatic stenosis of the subclavian artery: Open or endovascular approach? A case report. Int J Surg Case Rep. 2014;5(8):441–443.
9.
MagishiKIzumiYShimizuN. Short- and long-term outcomes of acute upper extremity arterial thromboembolism. Ann Thorac Cardiovasc Surg. 2010;16(1):31–34.
10.
KlitfodLJensenLP. Treatment of chronic upper limb ischaemia is safe and results are good. Dan Med J. 2014;61(6):A4859.
11.
ShionoyaS. Diagnostic criteria of Buerger’s disease. Int J Cardiol. 1998;66(suppl 1):S243–S245; discussion S247.
12.
ShionoyaS. What is Buerger’s disease?World J Surg. 1983;7(4):544–551.
13.
PengoVTripodiAReberG. Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2009;7(10):1737–1740.
14.
WisloffFJacobsenEMLiestolS. Laboratory diagnosis of the antiphospholipid syndrome. Thromb Res. 2002;108(5-6):263–271.
15.
DeguaraJAliTModaraiBBurnandKG. Upper limb ischemia: 20 years experience from a single center. Vascular. 2005;13(2):84–91.
16.
CoskunSSoyluLCoskunPKBayazitM. Short series of upper limb acute arterial occlusions in 4 different etiologies and review of literature. Am J Emerg Med. 2013;31(12):1719. e1–1719. e4.
17.
CerveraRPietteJCFontJ. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019–1027.
18.
HirschATCriquiMHTreat-JacobsonD. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–1324.
19.
BarbieroGCognolatoDCasarinAGuariseA. Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature. Radiol Med. 2011;116(6):919–931.
20.
JamesECKhuriNTFeddeCWGardnerRJTarnayTJWardenHE. Upper limb ischemia resulting from arterial thromboembolism. Am J Surg. 1979;137(6):739–744.
21.
ThompsonRW. Challenges in the treatment of thoracic outlet syndrome. Tex Heart Inst J. 2012;39(6):842–843.
22.
AndersenLVMortensenLSLindholtJSFaergemanOHennebergEWFrostL. Upper-limb thrombo-embolectomy: national cohort study in Denmark. Eur J Vasc Endovasc Surg. 2010;40(5):628–634.
23.
HotchkissRMarksT. Management of acute and chronic vascular conditions of the hand. Curr Rev Musculoskelet Med. 2014;7(1):47–52.
24.
BlechaMJ. Critical limb ischemia. Surg Clin North Am. 2013;93(4):789–812, viii.
25.
GalbraithKCollinJMorrisPJWoodRF. Recent experience with arterial embolism of the limbs in a vascular unit. Ann R Coll Surg Engl. 1985;67(1):30–33.
26.
Hernandez-RichterTAngeleMKHelmbergerTJauchKWLauterjungLSchildbergFW. Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter. Langenbecks Arch Surg. 2001;386(4):261–266.
27.
LichtPBBalezantisTWolffBBaudierJFRoderOC. Long-term outcome following thromboembolectomy in the upper extremity. Eur J Vasc Endovasc Surg. 2004;28(5):508–512.
28.
FariesPMorrisseyNJTeodorescuV. Recent advances in peripheral angioplasty and stenting. Angiology. 2002;53(6):617–626.
29.
MarderVJStewartD. Towards safer thrombolytic therapy. Semin Hematol. 2002;39(3):206–216.
30.
BangSLNalachandranS. Upper limb ischaemia - a single centre experience. Ann Acad Med Singapore. 2009;38(10):891–893.
31.
KretzJGWeissELimurisAEisenmannBGreffDKienyR. Arterial emboli of the upper extremity: a persisting problem. J Cardiovasc Surg (Torino). 1984;25(3):233–235.
32.
BaguneidMDoddDFulfordP. Management of acute nontraumatic upper limb ischemia. Angiology. 1999;50(9):715–720.
33.
QuraishyMSCawthornSJGiddingsAE. Critical ischaemia of the upper limb. J R Soc Med. 1992;85(5):269–273.
34.
DaviesMGO’MalleyKFeeleyMColganMPMooreDJShanikG. Upper limb embolus: a timely diagnosis. Ann Vasc Surg. 1991;5(1):85–87.
35.
AndersenLVLipGYLindholtJSFrostL. Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs. J Thromb Haemost. 2013;11(5):836–844.
36.
StonebridgePAClasonAEDuncanAJNolanBJenkinsAMRuckleyCV. Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review. Br J Surg. 1989;76(5):515–516.
37.
ChatapGGiraudKVincentJP. Atrial fibrillation in the elderly: facts and management. Drugs Aging. 2002;19(11):819–846.
38.
BairdRJLajosTZ. Emboli to the Arm. Ann Surg. 1964;160:905–909.
39.
SachatelloCRErnstCBGriffenWOJr. The acutely ischemic upper extremity: selective management. Surgery. 1974;76(6):1002–1009.
40.
SareGMGrayLJBathPM. Association between hormone replacement therapy and subsequent arterial and venous vascular events: a meta-analysis. Eur Heart J. 2008;29(16):2031–2041.
AdachiTSakamotoS. Thromboembolism during hormone therapy in Japanese women. Semin Thromb Hemost. 2005;31(3):272–280.
43.
HealeyJSConnollySJ. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am J Cardiol. 2003;91(10A):9G–14G.
44.
AndersenLVMortensenLSLipGY. Atrial fibrillation and upper limb thromboembolectomy: a national cohort study. J Thromb Haemost. 2011;9(9):1738–1743.
45.
ClarkCETaylorRSShoreACUkoumunneOCCampbellJL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012;379(9819):905–914.
46.
HaimoviciH. Cardiogenic embolism of the upper extremity. J Cardiovasc Surg (Torino). 1982;23(3):209–213.
47.
ZaracaFPonzoniASbragaPStringariCEbnerJAEbnerH. Does routine completion angiogram during embolectomy for acute upper-limb ischemia improve outcomes?Ann Vasc Surg. 2012;26(8):1064–1070.
48.
IslamAEdgertonCStaffordJM. Anatomic findings and outcomes associated with upper extremity arteriography and selective thrombolysis for acute finger ischemia. J Vasc Surg. 2014;60(2):410–417.
49.
MalgrasBMlynskiAPierretCFossatSde KerangalX. Hypothenar hammer syndrome: case report and review of the literature. J Mal Vasc. 2014;39(3):220–223.
50.
CarterPMHollinsheadPADesmondJS. Hypothenar hammer syndrome: case report and review. J Emerg Med. 2013;45(1):22–25.
HaimoviciH. Arterial thromboembolism of the upper extremity associated with the thoracic outlet syndrome. J Cardiovasc Surg (Torino). 1982;23(3):214–220.
54.
CromeCRRajagopalanSKuhanGFluckN. Antiphospholipid syndrome presenting with acute digital ischaemia, avascular necrosis of the femoral head and superior mesenteric artery thrombus. BMJ Case Rep. 2012;2012:10.1136/bcr-2012-006731.
55.
AshersonRACerveraRKlumbE. Amputation of digits or limbs in patients with antiphospholipid syndrome. Semin Arthritis Rheum. 2008;38(2):124–131.
56.
CrowtherMAGinsbergJSJulianJ. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med. 2003;349(12):1133–1138.
57.
RappJHReillyLMGoldstoneJKrupskiWCEhrenfeldWKStoneyRJ. Ischemia of the upper extremity: significance of proximal arterial disease. Am J Surg. 1986;152(1):122–126.
58.
SavelyevVSZatevakhinIIStepanovNV. Artery embolism of the upper limbs. Surgery. 1977;81(4):367–375.
BerridgeDCKesselDORobertsonI. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev. 2013;6:CD002784.
61.
RicottaJJScudderPAMcAndrewJADe WeeseJAMayAG. Management of acute ischemia of the upper extremity. Am J Surg. 1983;145(5):661–666.
62.
TurnerEJLohAHowardA. A conservative approach to acute upper limb ischemia. Vasc Dis Manag. 2010;7(11):219.
63.
DosluogluHHLallPHarrisLMDryjskiML. Long-term limb salvage and survival after endovascular and open revascularization for critical limb ischemia after adoption of endovascular-first approach by vascular surgeons. J Vasc Surg. 2012;56(2):361–371.
64.
KorhonenMBiancariFSoderstromM. Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis. Eur J Vasc Endovasc Surg. 2011;41(3):378–384.
