Long-term Outcomes of Nonoperative Management of Acute Nontraumatic Upper-limb Ischemia – A 5-years Follow-up

Abstract

Abstract Background: Acute upper-limb ischemia (AULI) is a sudden loss of perfusion to the affected limb. The annual incidence of AULI has been reported as 1.3 cases/100,000 patients. It can be due to vaso-occlusive or vasospastic disorders. It is often the result of thromboembolic disease, trauma, or iatrogenic factors. AULI has multiple modalities of treatment including surgical and nonsurgical options. Materials and Methods: Our study is a retrospective study where patients who have been conservatively treated at a single center between January 2015 and January 2018 were followed up for 5 years. Results: The analysis included 31 patients (61.3% males), with a mean age of 57 years. Only three patients presented within 6 h, and 16 patients presented more than 12 h after symptom onset. Of the 31 patients, 19% had a cardiac source of embolus, 65% had arterial thrombosis, and 16% had other etiologies. The axillary and brachial arteries were noted to be the most affected sites. All the patients underwent conservative management with anticoagulation. Results of this study showed that patients had amputation-free survival with improvement in clinical symptoms and functional outcomes at 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years. None of the patients required a surgical intervention for revascularization. At the end of 5 years of follow-up, two patients underwent partial amputations of one or more fingers, and limb salvage was achieved in all the patients. Most of the patients improved in terms of limb functionality from Grade 3 or Grade 4 at the time of presentation to Grade 1 according to functionality grading. Conclusion: Patients treated with conservative management for AULI have good amputation-free survival and good functional outcomes after 5 years as per our study.