Nonoperative Management of Acute Upper Limb Ischemia

Wong, Victor W.; Major, Melanie R.; Higgins, James P.

doi:10.1177/1558944716628499

Cited by 20 publications

(22 citation statements)

References 48 publications

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“…Several recent studies demonstrated good results for percutaneous thrombus aspiration. 7,10 The latter proved efficient in our patient, aiding the prompt recanalization of his radial artery and the palmar arch. However, in the clear majority of the previously reported cases, percutaneous treatment was assessed using a transfemoral access, which may be technically challenging due to kinked iliac, subclavian, and axillary arteries; therefore, in such cases, a direct puncture of the brachial artery may be a useful alternative.…”

Section: Discussionmentioning

confidence: 66%

Successful Endovascular Treatment of Acute Thromboembolic Upper Limb Ischemia in a Patient with Atrial Fibrillation

Giuşcă¹,

Schueler²,

Willersinn³

et al. 2018

Int J Angiol

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Acute limb ischemia represents a medical emergency that requires prompt diagnosis and treatment to preserve the viability of the affected tissue. The majority of the ischemic events are thrombotic in nature, especially in patients with atrial fibrillation. To date, surgical thrombectomy is usually used for the treatment of acute thromboembolic upper limb ischemia. Herein, we present a case of an 88-year-old patient who presented with right upper limb pain, pulselessness, and paresthesia. Duplex sonography revealed thrombotic occlusion and the absence of flow in both the ulnar and radial arteries. Electrocardiogram exhibited atrial fibrillation with a heart rate of 88 bpm. Antegrade puncture of the brachial artery was performed, and digital subtraction angiography confirmed fresh occlusion of the ulnar and radial arteries with some residual flow in the accessory brachial artery. Thrombus aspiration using a 6-Fr Eliminate aspiration catheter (Terumo Interventional Systems, Eschborn, Germany) was repeatedly performed, resulting in thrombolysis in myocardial infarction (TIMI) III antegrade flow to the right hand, promptly filling of the palmar arch and retrograde filling of the ulnar artery. Pain and paresthesia immediately resolved without need for further pharmacological interventions. The patient was discharged without functional deficits of his right hand, and duplex sonography after 4 weeks and 6 months revealed triphasic flow of the brachial and radial arteries and retrograde flow of the ulnar artery.

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Section: Discussionmentioning

confidence: 66%

Successful Endovascular Treatment of Acute Thromboembolic Upper Limb Ischemia in a Patient with Atrial Fibrillation

Giuşcă¹,

Schueler²,

Willersinn³

et al. 2018

Int J Angiol

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“…17 However, there is a lack of good quality evidence for non-surgical treatment and poor functional outcomes were more often seen after conservative treatment. 18 Thrombolysis is also an option for treatment of upper limb vascular occlusions being locally effective, 19 but up to 33% of treated patients have complications with the risk of hemorrhage, cerebrovascular events, and even death with its usage. 20 …”

Section: Discussionmentioning

confidence: 99%

Acute Upper Limb Ischemia: Prompt Surgery and Long-Term Anticoagulation Prevent Limb Loss and Debilitation

Harnarayan¹,

Islam²,

Harnanan³

et al. 2021

VHRM

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Background Acute upper limb ischemia is an uncommon clinical manifestation of thromboembolism seen predominantly in patients with atrial fibrillation. Treatment can be by conservative or surgical means but the consensus is that after conservative treatment, symptoms still persist. In this series, an attempt was made at limb preservation and return to functional capacity by early surgery in all patients diagnosed with acute limb ischemia. Methods Patients referred with upper limb ischemia (22) were stratified into non-acute (6) treated with anticoagulation alone and those with acute ischemia. Sixteen (16) patients, age range 30–92 years (median 62.4 years) comprising mainly females (13), had clinical evidence of severe ischemia and underwent immediate brachial embolectomy with postoperative anticoagulation. Results Sixteen patients underwent 20 embolectomies with immediate reperfusion of limbs and relief of symptoms. Two patients had two re-operations each due to recurrent symptoms but both recovered with good outcome, one going on to have an axillary-radial bypass. There was no limb disability nor limb loss, but one postoperative mortality. All other patients were seen at their 1-year review and at 5 years, eleven out of 15 patients were still alive with most resuming an active lifestyle and some returning to work. Conclusion Good outcomes were obtained in this series in both the short and long term. Despite one mortality, there was no limb loss nor disability in a mainly elderly population. Prompt surgery and meticulous long-term anticoagulation reduced complications and improved limb salvage rates ensuring that patients had a good quality of life after surgery.

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“…Furthermore, there is scant evidence for the safety and efficacy of massages. Treatment strategies for AULI, one of the possible massage complications, include thrombolytic therapy, endovascular intervention and surgical intervention [4], but many aspects of the treatment planning and decision making are determined by the practical capabilities and local availability of each facility [5].…”

Section: Introductionmentioning

confidence: 99%

A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

Matsue

Kuroki

Naganuma

et al. 2021

Kidney and Dialysis

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Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access.

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Nonoperative Management of Acute Upper Limb Ischemia

Cited by 20 publications

References 48 publications

Successful Endovascular Treatment of Acute Thromboembolic Upper Limb Ischemia in a Patient with Atrial Fibrillation

Successful Endovascular Treatment of Acute Thromboembolic Upper Limb Ischemia in a Patient with Atrial Fibrillation

Acute Upper Limb Ischemia: Prompt Surgery and Long-Term Anticoagulation Prevent Limb Loss and Debilitation

A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

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