Délai de revascularisation et complications dans l’ischémie aiguë du membre supérieur

Hammamia, M. Ben; Mrad, M. Ben; Mleyhi, Sobhi; Ziadi, J.; Ghedira, F.; Omrane, S. Ben; Kalfat, T.; Denguir, Raouf

doi:10.1016/j.jdmv.2019.02.003

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…As for surgical revascularization, previous studies show that revascularization either using bypass or arterialization were both efficient to improve UEDI when occurring in arteries of a large caliber as for DICE [28,29] . The surgical studies both recommend anticoagulant therapy after surgery which is consistent with our study where anticoagulant therapy was more often used in DICE [28–30] …”

Section: Discussionsupporting

confidence: 88%

“…[28,29] The surgical studies both recommend anticoagulant therapy after surgery which is consistent with our study where anticoagulant therapy was more often used in DICE. [28][29][30] This study has several limits; patients were included retrospectively during a significant period of 16 years and so there has been data loss. For idiopathic cases, we managed to find bloods tests results in 92.5% of the cases and morphological tests results in 86.6%.…”

Section: Discussionmentioning

confidence: 99%

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Digital ischaemia aetiologies and mid-term follow-up

Raimbeau¹,

Pistorius²,

Gouëffic³

et al. 2021

Medicine

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Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI. All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively. Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups ( P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients ( P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) ( P = .02) and the TAO group (n = 7) ( P = .03) than in DICE (n = 2). This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Digital ischaemia aetiologies and mid-term follow-up

Raimbeau¹,

Pistorius²,

Gouëffic³

et al. 2021

Medicine

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“…The time from reduction in the emergency department to fasciotomy in this patient was >13 h. The prolonged ischemia in the extremity likely contributed to the subsequent complications and need for recurrent incision and drainage. There is existing evidence regarding the increased risk of complications following acute limb ischemia within the first few hours [ 16 , 17 ]. Ben Hammamia et al found a significant risk of neurological sequelae with revascularization delays >12 h for acute upper-limb ischemia [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is existing evidence regarding the increased risk of complications following acute limb ischemia within the first few hours [ 16 , 17 ]. Ben Hammamia et al found a significant risk of neurological sequelae with revascularization delays >12 h for acute upper-limb ischemia [ 16 ]. Another study by Rothenberg et al demonstrated that delays to prophylactic fasciotomy >6 h result in a significantly increased risk of amputation at the 30-day mark [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Compartment Syndrome Due to Reperfusion Injury from an Axillary Artery Occlusion: A Case Report and Review of the Literature

Markowitz,

Donato,

Huntley

et al. 2023

JOCR

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Introduction: While commonly caused by traumatic injury and fracture, compartment syndrome can also result from reperfusion injury. Very few cases of prophylactic fasciotomy are mentioned when considering time to revascularization after prolonged vascular ischemia. We present a case of a patient who underwent multiple compartment prophylactic fasciotomies following reperfusion injury in the upper extremity. Case Report: We report a 72-year-old male that suffered from an anterior shoulder dislocation after a ground-level fall. After reduction, pulses were not measurable, and angiography indicated an axillary artery occlusion. Immediately after operative reperfusion, compartments became tense. Orthopedic surgeons subsequently performed arm anterior, posterior, and forearm volar and mobile wad compartment fasciotomies, after 13 h of ischemia. The patient tolerated the procedure, and at the latest follow-up, was working to improve strength in the extremity. Conclusion: Even when the circumstances of injury seem to be less traumatic as in this case of a ground-level fall, we document the importance of prompt recognition and intervention of suspected compartment syndrome following prolonged ischemia and revascularization of the upper extremity. Keywords: Compartment syndrome, reperfusion injury, shoulder dislocation, axillary artery occlusion, fasciotomy.

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