A Single-center, Seven Years Retrospective Study to Analyze the Outcomes of Acute Upper Limb Ischemia (AULI) in Northern India

Abstract

ABSTRACT Background: Acute upper-limb ischemia (AULI) is not always as limb-threatening as those in the leg, so thrombo-embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high-altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above-elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14-day period, among which one patient (11%) had undergone above-elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above-elbow-amputation patients (15%) with a statistically non-significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well-accepted first-line investigation for AULI. When we compare AULI with lower-limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower-limb ischemia has better limb salvage when diagnosed and intervened early.