Journal List > J Korean Surg Soc > v.79(6) > 1011209

TOOLS
Yi, Jung, Lee, Min, Min, Park, Ha, Chung, and Kim: Acute Arterial Thromboembolism of Upper Extremity
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(6): 491-496.

Published online: 31 December 2010

DOI: https://doi.org/10.4174/jkss.2010.79.6.491

Acute Arterial Thromboembolism of Upper Extremity

Jin Wook Yi, M.D.1, 2, In Mok Jung, M.D.1, 3, Taeseung Lee, M.D.1, 4, Seung-Kee Min, 1, 2, Sang Il Min, M.D.1, 2, Yang Jin Park, M.D.5, Jongwon Ha, M.D.1, 2, Jung Kee Chung, M.D.1, 3, Sang Joon Kim, M.D.1, 2

1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

2Department of Surgery, Seoul National University Hospital, Seoul, Korea.

3Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea.

4Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

5Department of Surgery, Samsung Medical Center, Seoul, Korea.

Corresponding author (imjung@brm.co.kr, sb5240@paran.com)

Received 19 June 2010       Accepted 9 August 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Acute Ischemia Of The Arm Is Uncommon Compared With Events In The Leg And Much Less Attention Has Been Paid To The Management Of Acute Arterial Thromboembolism Of The Upper Extremities. The Aim Of This Study Was To Evaluate The Clinical Aspects And Treatment Outcomes Of Acute Upper Extremity Thromboembolism.

Methods

From January 2007 to March 2010, seven patients underwent the management of upper extremity thromboembolism in three Seoul National University (SNU)-affiliated hospitals. We retrospectively reviewed the medical records.

Results

The mean age was 64.6 years (range 48~93 years) and 4 patients (57.1%) were female. Distribution of the thromboembolism were 4 in brachial, 1 in axillary plus brachial, 1 in ulnar and radial, and 1 in axillary artery, respectively. Time from symptom onset to presentation was 3.5 days (range 1~10 days). Primary treatment modality were Fogarty catheter embolectomy in 3 cases, bypass surgery in 1 case, and urokinase thrombolysis in 2 cases. A patient without symptoms was treated conservatively. Patients receiving primary thrombolytic therapy underwent surgical approach due to recurred thromboembolism during admission. In our 11.2 months of mean follow-up, there was recurrence but 1 patient died from cerebral infarction after 1.5 year of discharge.

Conclusion

In this study, functional outcome of acute upper extremity ischemia following appropriate treatments was excellent. Key features of treatment are shortening the time interval of diagnosis to primary treatment, proper anticoagulation, and treatment of underlying conditions. Larger-volume, long-term results and meta-analysis of upper extremity thromboembolism are required to establish standardized treatment in Korea.

Keywords: Acute ischemia, Upper extremity, Embolism, Thromboembolectomy

Figures and Tables

Fig. 1
CT angiography image of the thromboembolism at the level of right brachial artery bifurcation.
jkss-79-491-g001
Table 1
Clinical characteristics of patients (n=7)
jkss-79-491-i001
Table 2
Treatment and outcome of upper extremity thromboembolism (n=7)
jkss-79-491-i002

Mean follow up period: 11.17±8.18 months (range: 1~24 months).

References

1. Martinet O, Lauber AF, Marx A, Frauchiger B, Landmann J. Clinical aspects and diagnosis of arterial embolism of the upper extremity. Helv Chir Acta. 1994. 60:875–877.
2. O'Connell JB, Quiñones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg. 2009. 22:10–16.
3. Kim KH, Kwun WH, Lee DS, Suh BY, Kwun KB. Clinical analysis of acute limb ischemia. J Korean Soc Vasc Surg. 2003. 19:139–146.
4. Karapolat S, Dag Ö, Abanoz M, Aslan M. Arterial embolectomy: a retrospective evaluation of 730 cases over 20 years. Surg Today. 2006. 36:416–419.
5. Ueberrueck T, Marusch F, Schmidt H, Gastinger I. Risk factors and management of arterial emboli of the upper and lower extremities. J Cardiovasc Surg (Torino). 2007. 48:181–186.
6. Kairaluoma MI, Kärkölä P, Larmi TK. Surgical treatment of arterial embolism. Fifteen years experience. Ann Chir Gynaecol. 1976. 65:163–167.
7. Bergqvist D, Ericsson BF, Konrad P, Bergentz SE. Arterial surgery of the upper extremity. World J Surg. 1983. 7:786–791.
8. Licht PB, Balezantis T, Wolff B, Baudier JF, Røder OC. Long-term outcome following thrombembolectomy in the upper extremity. Eur J Vasc Endovasc Surg. 2004. 28:508–512.
9. Koyama T, Funaki S, Nishimura K, Kanno M, Abe H, Hiekata T. Acute arterial obstruction of the upper extremities. Jpn J Vasc Surg. 2000. 9:479–483.
10. Hernandez-Richter T, Angele MK, Helmberger T, Jauch KW, Lauterjung L, Schildberg FW. Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter. Langenbecks Arch Surg. 2001. 386:261–266.
11. Pousios D, Velissaris T, Duggan S, Tsang G. Floating intra-aortic thrombus presenting as distal arterial embolism. Interact Cardiovasc Thorac Surg. 2009. 9:532–534.
12. Edwards NM, Casey R, Johnson R. Extensive arterial embolus in the arm of a college runner with thoracic outlet syndrome: a case report. Clin J Sport Med. 2009. 19:331–332.
13. Eyers P, Earnshaw JJ. Acute non-traumatic arm ischaemia. Br J Surg. 1998. 85:1340–1346.
14. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009. 22:5–9.
15. Go AS, Hylek EM, Chang Y, Phillips KA, Henault LE, Capra AM, et al. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? JAMA. 2003. 290:2685–2692.
16. Fogarty TJ, Daily PO, Shumway NE, Krippaehne W. Experience with balloon catheter technic for arterial embolectomy. Am J Surg. 1971. 122:231–237.
17. Magishi K, Izumi Y, Shimizu N. Short- and long-term outcomes of acute upper extremity arterial thromboembolism. Ann Thorac Cardiovasc Surg. 2010. 16:31–34.
TOOLS
Similar articles