Outcomes of Surgical Revascularization for Acute Upper Limb Ischemia— A Single-Center Retrospective Analysis

Background: Acute upper limb ischemia (AULI) is a medical emergency with high perioperative complication rates; however, these are poorly reported. The aim of this study is to report the complication rates following surgical revascularization in AULI. 

Methods: Retrospective analysis of all patients undergoing brachial embolectomy for AULI from January 2010 to October 2021 was included. Data for baseline demographic characteristics, site of arterial occlusion, cancer status, and the potential underlying etiology were included. Outcomes included technical success, early reintervention, local and systemic complications, functional limb outcome at follow-up, and amputation. 

Results: 96 patients were identified. Computed tomography angiography was the first line diagnostic imaging modality, with the brachial bifurcation as the most common location for obstruction. The initial technical success rate was 76.4% (n = 73). Major adverse events occurred in 11.5% patients (n = 11); 8.3% had perioperative stroke and 7.3% resulted in in-hospital death (4.2% had both). Local complications occurred in 24%; 7.3% had site hematoma, 11.5% had early thrombosis, and 4.2% had 30-day thrombosis. 2.1% resulted in amputation. No variables were identified as having significant association with local surgical complications. 

Conclusions: AULI is often associated with underlying systemic and cardiac disorders. An evidence based approach to guide the nonoperative management of AULI is lacking. In appropriately selected patients, Fogarty thrombectomy has a reasonable technical success rate; however, the associated perioperative complication rate is high, both locally and systemically. Further studies of larger sample size are needed to identify negative predictors and reduce perioperative complications in this challenging cohort.