OUTCOME OF SURGICAL-TREATMENT IN ACUTE UPPER-LIMB ISCHEMIA

During a 26 years' period, 547 thromboembolectomies were undertaken fo r 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), col dness (94), pain (85), paraesthesia (45) and dysfunction (45) of the a ffected limb were the main symptoms. The right upper limb was more oft en affected (59/38, P < 0,05). An embolus orginating from the heart wa s the reason for the ischaemia in 71 cases, while in 11 cases the occl usion was caused by a local thrombosis. In 15 cases the origin of the embolus remained unsolved. In five cases an additional arterial recons truction was needed to restore the circulation. Re-embolectomy of the same limb was needed in five cases, and additionally in two patients, a third embolectomy was unavoidable. A secondary humeral amputation wa s necessary for one patient. Eleven patients (11.3%) died within 30 da ys 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 fu nctional result was achieved in 78 cases (80.4%). The clinical results was in ischaemia caused by embolism are markedly better than those of local thrombosis (P < 0.001).