Outcome Analysis of Upper Limb Ischemia – Our Institutional Experience

Abstract

Introduction: Upper limb ischaemia (ULI) is a relatively  uncommon, but well recognized vascular condition. It         includes between 15-18% of the procedures that have been done for critical limb ischemia. This research study was aimed at developing not only a comprehensive but also a broad overview of ULI, specific to the population we serve.

Aim: The objective of this study was to review the                    experience of upper limb ischemia, both acute and chronic, of a single centre, the Institute of Vascular Surgery, Madras medical college, with particular emphasis on the pattern and         distribution of the disease, their pathological profile, and   reporting their outcomes with comparison to the literature on this topic.

Methods: Retrospective descriptive analysis. All patients who were admitted with symptoms and signs of upper limb ischemia were identified between august 2012 and august 2015 were included in the audit. Data were collected from the patients’ case notes and hospital registries. Upon collection of the data, the findings were analysed and compared to the recent literature on this topic. 

Results: A total of 192 patients were included in the study. Of which 111 patients underwent revascularization procedures. The most common etiology for acute upper limb ischemia was traumatic injury (n=58) followed by   thromboembolic disease (n=37) and that for chronic limb ischemia was atherosclerosis (n=47) followed by                                                                                                                                                                                                                                                                                                        thromboangiitis obliterans (n=17). The mean age of distribution is 41.1 years. The extent of neurological damage could not be elicited for all the patients with traumatic injuryand conclusive data on the functional status of the  salvaged limb were lacking. All patients who underwent embolectomy had a fasciotomy done routinely as part of the institutional protocol for thromboembolic disease. No mortality occurred in this group. Most of the patients with atherosclerotic occlusion and TAO were managed             conservatively. All patients with TOS had their limb    salvaged.

 Conclusion: Upper limb ischemia though relatively            uncommon, has a major impact on the functional status of the patients. Although firm conclusions cannot be drawn, it is anticipated that our institutional data will provide clinical awareness and facilitate comparison of similar                    experiences in different institutes enabling pooled data analysis. This may further define the various patterns of upper limb arterial disease and improve the outcome, perhaps by identifying other confounders.