Management of acute ischemia of the upper extremity

Ricotta, John J.; Scudder, Paul A.; McAndrew, John A.; Weese, James A. De; May, Allyn G.

doi:10.1016/0002-9610(83)90117-4

Cited by 38 publications

(26 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The second most common cause of arterial occlusion was iatrogenic (1.5%). 28,36,39,43 Of 976 patients with thromboembolic occlusion, 752 cases (77%) were attributed to cardiac origin disease. The most frequent sites of thromboembolic occlusion were the brachial (48%) and axillary (15%) arteries.…”

Section: Resultsmentioning

confidence: 99%

“…Ricotta et al reported that chronic paresthesias were present in 3 of 15 patients (20%) with catheter-induced AULI. 36 HernandezRichter et al reported that 6 of 111 long-term patients (5.1%) had arm pain only with heavy exercise, whereas the remainder had no or minimal symptoms with exercise. Licht et al reported that 9 of 57 patients (13%) had slightly decreased arm function and 2 (3%) had severe functional defects that did not correlate with symptom duration prior to intervention.…”

Section: Percutaneous Catheter Embolectomymentioning

confidence: 99%

“…17 Ricotta et al managed 13 of 44 AULI patients (30%) presenting with cardiac emboli with conservative treatment consisting of observation with or without anticoagulation therapy. 36 Seven patients were unfit for surgery and 4 died within 36 hours of evaluation (30% mortality). Five patients were observed and showed gradual improvement, and 1 patient presented several weeks after the initial event with gangrene requiring digital amputation.…”

Section: Anticoagulation and Medical Therapymentioning

confidence: 99%

“…2,3,10,17,27,36,39,42,43 In general, indications for medical management included either mild symptoms or patients deemed too sick for invasive interventions. A study from the pre-endovascular era demonstrated considerable morbidity with the medical treatment of AULI.…”

Section: Anticoagulation and Medical Therapymentioning

confidence: 99%

See 3 more Smart Citations

Nonoperative Management of Acute Upper Limb Ischemia

Wong

Major

Higgins

2016

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Background: Acute upper limb ischemia (AULI) is an uncommon emergency warranting immediate evaluation and treatment. The role of nonsurgical therapies including endovascular techniques, thrombolytics, and anticoagulation remains undefined. The authors systematically reviewed the current literature on the nonsurgical treatment of acute ischemia of the upper extremity. Methods: A PubMed and Embase search was conducted, and articles were screened using predetermined criteria. Data collected included patient demographics, cause of upper limb ischemia, type of nonsurgical treatment used, treatment outcomes, and complications. Patients were divided into 4 treatment groups: catheter embolectomy, catheter-directed thrombolysis, endovascular stenting, and anticoagulation/medical therapy alone. Results: Twenty-three retrospective studies met the search criteria. Of 1326 reported occlusions, 92% (1221) were attributed to thromboembolic disease. The second most common cause was iatrogenic (1.5%). Overall limb salvage rates were excellent with catheter embolectomy (862 of 882 cases, 97.7%) and catheter-directed thrombolysis (110 of 114 cases, 96.5%). Limb salvage rates were also high with anticoagulation/medical therapy (158 of 165 cases, 95.8%), but poor functional outcomes were more often reported. Conclusions: High-quality evidence to guide the nonsurgical treatment of AULI is lacking. Retrospective studies support the utility of catheterbased embolectomy and thrombolysis for distal ischemia. Whether a surgical or nonsurgical approach is taken, anticoagulation therapy remains a mainstay of both treatment and prevention of AULI. Because AULI patients often have underlying cardiac and/or systemic disease, a multidisciplinary approach is essential to minimize complications and prevent future occurrences.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Percutaneous Catheter Embolectomymentioning

confidence: 99%

Section: Anticoagulation and Medical Therapymentioning

confidence: 99%

Section: Anticoagulation and Medical Therapymentioning

confidence: 99%

See 2 more Smart Citations

Nonoperative Management of Acute Upper Limb Ischemia

Wong

Major

Higgins

2016

Hand (New York, N,Y.)

View full text Add to dashboard Cite

show abstract

“…Clinical symptoms include a cold, painful extremity with sensory or motor deficit and absent pulses. Thrombo-embolectomy, heparin anticoagulation, systemic or intra-arterial vasodilation, sympathetic, stellate ganglion or brachial plexus blocks were described as therapeutic measures [4,5,8,13,14]. Local arterial infusion of thrombolytic agents has been reported as an alternative by Dotter et al [15].…”

mentioning

confidence: 99%