Upper limb ischemia resulting from arterial thromboembolism

Acute Brachial Artery Occlusion — Diagnosis and Treatment

“…1-3,5-7 Brachial artery embolism has been recorded in 6 % -8 % of all peripheral emboli and is often seen in patients with multiple emboli to other arteries . [2][3][4]6,7 Why do arteries in the upper extremity get fewer emboli than the other arteries of the body? The comparative infrequency of upper limb emboli is probably due to anatomic factors.…”

“…A large, heavy embolus is less likely to leave the aortic stream and, missing the arteries coming off the aortic arch, passes on to the lower extremities.4 The emboli that do lodge in the upper extremity are likely to be small, and in series reported in the literature, 65 % of these emboli lodged in the brachial artery, 30 % in the axillary, and 5 % in the subclavian arteries . 4 Symptoms of brachial emboli vary, with about one half of patients presenting only with pain, pallor, and coldness, and the remainder having more severe symptoms of pain, paralysis, and cyanosis. The most common symptom is pain.…”

Systematic review of the operative and non-operative management of acute upper limb ischemia

“…1,6,10,20,21 Causes of AULI The most common causes of AULI -summarized in Table 2 -include embolism (47%), thrombosis (28%) and trauma (25%). 22 Cardiac causes are reported as the most frequent source of emboli followed by emboli from proximal vessels. 1,5,8,11 The patients with emboli from proximal vessels tended to be young and male.…”

“…[1][2][3]6,10,13,23,24 The management of AULI depended on the underlying pathological lesion, and this was determined clinically, using Doppler and via angiography. [1][2][3]6,10,13,20,22,23 The consensus in the literature was that emboli should be treated with immediate intravenous heparin anticoagulation. Further management varied from article to article, but the vast majority reported use of thromboembolectomy as the primary procedure, followed rarely by arterial bypass surgery.…”

“…2 Eyers and Earnshaw reviewed the literature and found that between 9% and 30% of patients with AULI were treated conservatively. 2,5,19,21,22,33 They noted that the patients selected had either mild symptoms or a medical condition preventing invasive treatment including those under local anesthetic. 18 The overall conclusion from the literature was that late presentation and failure to rapidly anticoagulate were uniformly associated with worse outcome and prognosis.…”