Eyers P, Earnshaw J J
Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Gloucester, UK.
Br J Surg. 1998 Oct;85(10):1340-6. doi: 10.1046/j.1365-2168.1998.00884.x.
Much attention has been paid to the management of acute leg ischaemia. Acute arm ischaemia is perceived as less of a problem because the risk of limb loss is lower. After conservative treatment up to half the patients have late symptoms, such as forearm claudication.
This study was a review of all published English language data on acute arm ischaemia. The entire Medline database was searched and other references were derived from the material perused. There were no randomized or controlled studies.
The incidence of acute arm ischaemia is one-fifth that of acute leg ischaemia. Patients with arm ischaemia tended to be older with a mean age of 74 years compared with 70 years for acute leg ischaemia. Since the development of the embolectomy catheter, embolectomy can be performed in most patients under local anaesthetic. Collected outcome included successful restoration of the circulation in 65-94 per cent of patients and amputation in 0-18 per cent. The mortality rate ranged from 0 to 19 per cent, despite the use of local anaesthesia, mostly from associated cardiac disease. Management by a vascular specialist may be beneficial, particularly in complex cases.
An active approach to the management of acute arm ischaemia is safe and effective and reduces the risk of late disabling symptoms.
急性下肢缺血的治疗已受到广泛关注。急性上肢缺血被认为问题较小，因为肢体丧失的风险较低。保守治疗后，多达一半的患者会出现晚期症状，如前臂间歇性跛行。
本研究回顾了所有已发表的关于急性上肢缺血的英文资料。检索了整个Medline数据库，并从阅读的材料中获取了其他参考文献。没有随机对照研究。
急性上肢缺血的发病率是急性下肢缺血的五分之一。上肢缺血患者往往年龄较大，平均年龄为74岁，而急性下肢缺血患者为70岁。自从取栓导管问世以来，大多数患者可以在局部麻醉下进行取栓术。收集的结果包括65%至94%的患者循环成功恢复，0%至18%的患者截肢。死亡率在0%至19%之间，尽管使用了局部麻醉，主要死因多为相关的心脏疾病。由血管专科医生进行治疗可能有益，尤其是在复杂病例中。
积极治疗急性上肢缺血是安全有效的，并可降低晚期致残症状的风险。
