X. Papon et al., Severe and distal ischemia of the upper limb. Results of a surgical follow-up of 11 years in 34 patients., J MAL VASC, 24(5), 1999, pp. 368-372
The aim of this retrospective study was to evaluate etiology, frequency and
prognosis of the distal and severe arterial diseases of the upper limb tre
ated in a vascular surgical unit.
Between Jan.1986 and Jan.1997, 34 patients, 22 males and 12 females, mean a
ge 56 years (range 30 to 87 years) were followed in the vascular and thorac
ic surgical unit in Angers. Follow-up was 100% complete. Each patient was e
xplored by selective angiography of the upper limb due to the critical char
acteristic of ischemia.19 patients (56%) had tissue loss.
Among multiple etiologies, arteriosclerosis was found in 32% of the cases.
When medical treatment was unsuccessful, a thoracic sympathectomy was attem
pted in 50% of the cases, and 21% of the patients had direct arterial surge
ry. Nine deaths, due to initial pathology, occurred during follow-up. Eight
digitalis amputations were carried out whose two directly because serious
necrosis. Severe arterial diseases of the upper limb represented 6,4% of cr
itical limb ischemia treated during this same period.
At time, this study showed arteriosclerosis preponderance over systemic dis
eases, and the seriousness of cases referred to a vascular surgical center
after unsuccessful medical treatment (J Mal Vase 1999; 24: 368-372).