Specific characteristic of acute upper limb arterial ischemia: analysis of a 114 patients cohort

Abstract

Background: Acute upper limb arterial occlusion is an uncommon condition in peripheral arterial disease. Only small series and case reports can be retrieved from a systematic review of the literature. The goal of our study was to retrospectively identify acute upper limb occlusion patients from our institutional data base to characterize their clinical background and etiologies. Methodes: 2000 patients were retrieved from electronic database (using ICD10 code I.742) of the European Hospital since 2000. We choose at first stage to analyze the cohort of our vascular medicine department in order to exclude most of the post interventional or surgical procedures acute limb ischemia whom are hospitalized in surgical or cardiology department. 114 consecutive patients hospitalized in the vascular medicine unit were identified. Accurate diagnosis was established by 2 independent observers based on the review of each medical report and each examination performed. Results: The mean age was 56.2±17.4, male represents 52.6%. The main cardiovascular risk factor was smoking (56%), followed by hypertension (46%) and hypercholesterolemia (37%). Only 15% had family history of cardiovascular disease, and 10% had diabetes mellitus. The leading cause was professional disease or Hammer Syndrome (13%), followed by cardioembolism (12%) including AF, flutter, intraventricular thrombus and atherosclerotic plaque embolism (sub-clavian stenosis most oftenly). Iatrogenic disease comes next (11%), with: intraarterial drug infusion, chemotherapy, radiotherapy. Thromboangeitis obliterans represented 9%, connective tissue diseases (systemic sclerosis, rheumatoid arthritis) 7%, malignancy (myeloproliferative disorders, solid neoplasia) 7%, thoracic outlet syndrom 5% and the same rate for thrombophilia, and finally large vessels vasculitis (Takayasu, Giant cell disease) was retrieved in 3% of cases along with paradoxical embolism (3%). Although a 3 years follow-up and wide explorations no evidence for a specific aetiology was found in 13% of the cases. Conclusion: We reported here one of the widest cohort of acute upper limb arterial occlusion. Our results suggest that the occurrence of an upper limb arterial occlusion should lead to a very exhaustive investigations, as the distribution of the aetiologies completely differs from those found in lower limb. Hammer syndrome and cardioembolism are the most prevalent causes before atherosclerosis. Iatrogenic disease should not be ignored including drug adverse event, or intraarterial infusion. Unfortunately, 1 of 7 patients remains idiopathic.