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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2005 June;12(2):65-9
Acute upper limb ischemia of embolic origin: 682 cases
La Marca G., La Barbera G., Rinaudo G., Ricevuto G., Martino A.
Vascular Surgery Unit Benfratelli and City Hospital, Palermo, Italy
Aim. Acute upper limb ischemia is easily diagnosed on a clinical basis and is usually observed in old patients with atrial fibrillation, sclerotic cardiopathy and mitralic valvulopathy who suddenly complain of a oulseless, painful, cold and pale arm. Clinical evolution depends upon the occlusion site, the extension of arterial thrombosis and pre-existent collateral circulation pathways. The aim of the paper is to report our experience in the treatment of this disease.
Methods. A total of 2553 patients presenting with upper or lower limbs acute ischemia of embolic origin have been operated at the Vascular Surgery Unit of the City Hospital of Palermo from 1968 to 2002. All interventions have been carried out with Fogarty technique. Upper limb ischemia was observed in 682 patients. The authors indicate that incidence of upper limb embolisms is increasing compared to embolisms of all body districts, and that mean age of patients is becoming older and older. Patients have been grouped according to gender, site of embolic occlusion, age, presentation delay and to embolus origin.
Results. The results show that limb salvage is independent from gender and age (always more than 90%); a longer presentation delay increases amputation rate, and limb salvage without radial pulse appraisal. Mortality is not related to the surgical therapy and is independent from above mentioned variables.
Conclusion. Diagnosis is usually easy, and angiography is reserved to those few cases without cardiopathy where the embolic source is uncertain.