Management of acute nontraumatic upper limb ischemia

A retrospective review of all patients presenting to a tertiary referral ce nter with acute nontraumatic upper limb ischemia between January 1992 and J une 1997 was undertaken to examine the role of intraarterial thrombolysis i n the management of such cases. Twenty-one patients were identified in the radiology and vascular surgery departments' registers. Twenty (95%) underwe nt angiography, demonstrating subclavian artery occlusion in four, axillary in two, brachial in 13, and one at the digital level. Intraarterial thromb olysis was attempted in 12 patients. There were three technical failures, a ll requiring embolectomy. Six had complete lysis and resolution of their sy mptoms. One patient had partial lysis but experienced no further rest pain. Thrombolysis was unsuccessful in two cases with one subsequently requiring embolectomy and the other surgical bypass. Three patients had surgical int ervention as their primary procedure with two favorable outcomes and one en ding in above-elbow amputation. Five patients were treated conservatively w ith heparin, resulting in three partial and two full recoveries. One patien t experienced complete resolution of symptoms with an intravenous prostacyc lin infusion. Both electrocardiograms (ECG) and echocardiograms (ECHO) were of limited diagnostic aid, and long-term warfarin anticoagulation was pres cribed to all patients. There was no recurrence of upper limb ischemia at a median follow up of 18 months. Intraarterial thrombolysis is an effective first line treatment for acute nontraumatic upper limb ischemia in selected cases.