d'Addato M, Pedrini L
Service de Chirurgie Vasculaire, Hôpital S.-Orsola, Bologne, Italie.
J Mal Vasc. 1996;21(5):303-7.
Among a series of 286 cases of acute ischemia of the upper limb, we analyzed the files of 176 patients (61.5%) with noncardiac ischemia in order to identify the causes and treatment. Trauma was the most frequent cause (126 cases) including trauma of the forearm especially due to stab wounds. Lesions with a subclavian-axillary localization were predominantly due to tear wounds or blunt trauma. We analyzed two groups among the trauma cases: iatrogenic lesions (9 cases) usually resulted from orthopedic surgery (5 cases) or vascular catheterization (3 cases) as well as near-total limb amputations (13) cases. Thrombosis of the subclavian artery occurred in 33 patients; 9 had acute ischemia including 3 due to a cervical rib and 6 due to compression by the rib and the clavicle. Only 4 of these 33 patients suffered ischemia of the hand due to embolization. Acute ischemia was caused by arteriopathy of the hand in 8 patients including 2 volley ball players, 1 baseball player and 3 subjects with occupational microtrauma and 1 with thrombosis of the palmar arch. Finally 1 patient had thrombosis after intravenous drug injection. These files demonstrated the variety of non-cardiac causes of acute ischemia of the upper limb. During the acute phase, we propose locoregional thrombolysis in case of thrombosis and embolectomy for emboli followed by treatment of the casual lesion. An arteriography is essential for correct diagnosis and should include the subclavian artery in the hyperabduction position and the hand. Duplex scanning of the subclavian artery is indicated in case of ischemia of the hand using the Adson, McGowan and Wright maneuvers in order to guide the radiologist for invasive radiography before initiating appropriate treatment.
在286例上肢急性缺血病例中，我们分析了176例（61.5%）非心脏性缺血患者的病历，以确定病因和治疗方法。创伤是最常见的病因（126例），包括前臂创伤，尤其是刺伤。锁骨下 - 腋窝部位的损伤主要是撕裂伤或钝器伤。我们在创伤病例中分析了两组：医源性损伤（9例）通常由骨科手术（5例）、血管导管插入术（3例）以及近乎全肢截肢（13例）引起。33例患者发生锁骨下动脉血栓形成；9例出现急性缺血，其中3例由于颈肋，6例由于肋骨和锁骨压迫。这33例患者中只有4例因栓塞导致手部缺血。8例患者的急性缺血由手部动脉病变引起，包括2名排球运动员、1名棒球运动员、3名有职业性微创伤的受试者和1名掌弓血栓形成患者。最后，1例患者在静脉注射毒品后发生血栓形成。这些病历显示了上肢急性缺血的多种非心脏性病因。在急性期，对于血栓形成，我们建议进行局部溶栓，对于栓子进行栓子切除术，随后治疗偶然病变。血管造影对于正确诊断至关重要，应包括处于过度外展位置的锁骨下动脉和手部。如果手部缺血，应使用阿德森（Adson）、麦高恩（McGowan）和赖特（Wright）手法对锁骨下动脉进行双功扫描，以便在开始适当治疗前指导放射科医生进行侵入性放射检查。
