Treatment of chronic upper limb ischaemia is safe and results are good

Dan Med J. 2014 Jun;61(6):A4859.

Abstract

Introduction: Chronic ischaemia of the upper extremity is rare, and only a few small studies are published on results after revascularisation. We found it of interest to present this larger population-based registry-study of patients treated for chronic ischaemia of the upper limb by open or endovascular procedures.

Material and methods: A total of 101,725 primary arterial vascular procedures in the Danish National Vascular Registry (Karbase) were recorded from 1.1.1993 to 31.12.2011. Of these, a total of 453 (0.4%) procedures were performed for chronic stenotic disease of the proximal arteries of the upper limb, 233 endovascularly and 220 by open surgery.

Results: Open reconstructions: Two patients died within 30 days, which is equivalent to a mortality rate of 0.9%. Six (2.7%) reconstructions occluded before discharge. Complications were observed in 41 patients (19%); the complications were predominantly related to surgical wound. At follow-up, 74 (70%) had no symptoms. Endovascular reconstructions: There were six deaths within the first 30 days, which is equivalent to an early mortality rate of 2.6%. Four (2%) reconstructions occluded before discharge. Complications were observed for 23 (10%) patients; the complications were predominantly of neurovascular origin. At follow-up, 90 (74%) had no symptoms. The one-year survival was 95% with no difference between the two groups.

Conclusion: Chronic ischaemia of the upper limb can be treated both with open surgery and endovascularly with acceptable results. There was an excellent one-year patency rate for the patients who showed up for follow-up; the patency rate was comparable to that reported in the literature.

Funding: not relevant.

Trial registration: not relevant.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty*
  • Chronic Disease
  • Denmark
  • Female
  • Follow-Up Studies
  • Hematoma / etiology
  • Humans
  • Ischemia / surgery*
  • Length of Stay
  • Lymphedema / etiology
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Registries
  • Upper Extremity / blood supply*
  • Young Adult