Outcome of surgical treatment in acute upper limb ischaemia.

During a 26 years' period, 547 thromboembolectomies were undertaken for acute limb ischaemia. The portion of upper limb ischaemia was 17.7% (97/547). The annual incidence of surgically treated acute upper limb ischaemia was 1.3 cases/100,000/year during the last 15 years of study period. There were 91 patients, 45 males and 46 females, ranging from 17 to 92 years with a median age of 73 years. Pulselessness (96), coldness (94), pain (85), paraesthesia (45) and dysfunction (45) of the affected limb were the main symptoms. The right upper limb was more often affected (59/38, P < 0.05). An embolus originating from the heart was the reason for the ischaemia in 71 cases, while in 11 cases the occlusion was caused by a local thrombosis. In 15 cases the origin of the embolus remained unsolved. In five cases an additional arterial reconstruction was needed to restore the circulation. Reembolectomy of the same limb was needed in five cases, and additionally in two patients, a third embolectomy was unavoidable. A secondary humeral amputation was necessary for one patient. Eleven patients (11.3%) died within 30 days and of these nine did so from recurrent embolism. The mortality was not related to the duration of the ischaemia, but rather to patients' general condition. During a mean follow-up time of 50 weeks a good functional result was achieved in 78 cases (80.4%). The clinical results in ischaemia caused by embolism are markedly better than those of local thrombosis (P < 0.001).