A Surgical Overview of 200 Patients with Acute Arterial Occlusions of the Vessels of the Arm

Abstract

Two hundred patients (103 men, 97 women, average age sixty-three years) with acute arterial occlusion of the vessels of the arm (AAOVA) were treated surgically in the period from January, 1985, to May, 1991 70.5% of the occlusions were due to emboli and 29.5% were due to primary thrombosis. The subclavian/axillary arteries were occluded in 29% of the cases, the brachial artery in 59%, and the radial/ulnar arteries in 12%; 77.6% of the subclavian/axillary obstructions were due to emboli and 22.4 to thrombosis, 72.9% of the brachial obstructions were due to emboli and 27.1% to thrombosis, and 41.7% of the radial/ulnar obstructions were due to emboli and 58.3% to thrombosis.Local anesthesia was employed for all patients. There were 49 reoperations: 27 for rethrombosis, 8 for reembolization, 9 for evacuation of hematomas or control of hemorrhage, and 5 for treatment of infection; 11 fasciotomies were performed. Ten (5%) of the patients died, primarily because of cardiac failure or strokes. In 169 patients (84.5%) one or both distal pulses were restored at the wrist with return of normal extremity function. In 22 patients (11%), distal pulses were not restored but the clinical results were satisfactory. In 9 patients (4.5%), amputation at various levels was necessary owing to delayed presentation for treatment, extended thrombosis, or poor vascular status.