Differences Between Acute Nontraumatic Upper and Lower Extremity Ischemia

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The aim of this study was to analyze the differences in natural perioperative history and risk factors in patients with acute upper and lower extremity ischemia. According to the national vascular registry (FINNVASC) for the period January 1991-November 1992, 599 patients were treated in Finland for acute extremity ischemia. Ninety (15%) patients were treated for acute upper limb ischemia and 509 (85%) for acute lower limb ischemia. Upper extremity ischemia was more common in women (P < 0.05). Patients with acute upper limb ischemia were older, 77.1 versus 73.2 years (P < 0.001). The embolus/thrombosis ratio in patients with acute upper extremity ischemia was 90/10% as against 62.5/37.5% in patients with acute lower extremity ischemia (P < 0.001). Smoking was more common in patients with acute lower extremity ischemia (P < 0.05). No other difference was noted in risk factors between the upper and lower extremity groups. No amputation of an upper limb was done. Mortality after acute upper extremity ischemia was 5.6% and after acute lower extremity ischemia 12.8% (P=0.07). The authors conclude that acute upper limb ischemia was most often caused by embolism and these patients were more often older and women as compared with patients with acute lower limb ischemia. Upper limb ischemia was also more common in the right upper limb. No upper limb amputation was done; however, mortality among these patients was not significantly lower.