Vascular Health and Risk Management (Aug 2021)
Acute Upper Limb Ischemia: Prompt Surgery and Long-Term Anticoagulation Prevent Limb Loss and Debilitation
Abstract
Patrick Harnarayan,1 Shariful Islam,2 Dave Harnanan,1 Vinoo Bheem,2 Steve Budhooram3 1Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine, Trinidad &Tobago; 2Department of Surgery, San Fernando General & Teaching Hospitals, San Fernando, Trinidad &Tobago; 3The Surgi-Med Clinic, San Fernando, Trinidad & TobagoCorrespondence: Patrick Harnarayan Email [email protected]: Acute upper limb ischemia is an uncommon clinical manifestation of thromboembolism seen predominantly in patients with atrial fibrillation. Treatment can be by conservative or surgical means but the consensus is that after conservative treatment, symptoms still persist. In this series, an attempt was made at limb preservation and return to functional capacity by early surgery in all patients diagnosed with acute limb ischemia.Methods: Patients referred with upper limb ischemia (22) were stratified into non-acute (6) treated with anticoagulation alone and those with acute ischemia. Sixteen (16) patients, age range 30– 92 years (median 62.4 years) comprising mainly females (13), had clinical evidence of severe ischemia and underwent immediate brachial embolectomy with postoperative anticoagulation.Results: Sixteen patients underwent 20 embolectomies with immediate reperfusion of limbs and relief of symptoms. Two patients had two re-operations each due to recurrent symptoms but both recovered with good outcome, one going on to have an axillary-radial bypass. There was no limb disability nor limb loss, but one postoperative mortality. All other patients were seen at their 1-year review and at 5 years, eleven out of 15 patients were still alive with most resuming an active lifestyle and some returning to work.Conclusion: Good outcomes were obtained in this series in both the short and long term. Despite one mortality, there was no limb loss nor disability in a mainly elderly population. Prompt surgery and meticulous long-term anticoagulation reduced complications and improved limb salvage rates ensuring that patients had a good quality of life after surgery.Keywords: acute-ischemia, prompt-surgery, anticoagulation, limb-salvage
