title: Atraumatic acute upper limb ischemia: a series of 64 patients in a Middle East tertiary vascular center and literature review.
abstract: This paper documents the various causes of upper limb ischemia in a series of 64 Egyptian patients presenting to a tertiary referral center over a 4-year period and offers a diagnostic dissertation and review of the pertinent literature. Atraumatic upper limb ischemia is an uncommon entity. It has a broad etiology with diverse management pathways. Nineteen patients presented with severe and immediate limb-threatening ischemia. These patients underwent immediate surgical exploration: an embolus was diagnosed in 15 and thrombosis in 4. Twenty-eight patients presented with ischemia of lesser severity, allowing preoperative angiography. Of these 28 patients, 6 had an embolus, 14 had thrombosis, 4 had thoracic outlet syndrome, the remainder had miscellaneous causes. Fifteen patients had upper limb ischemia secondary to arteritis, and 2 patients with dissection of the ascending thoracic aorta presented with upper limb ischemia. Forty-seven patients underwent a surgical procedure, with a morbidity rate of 21% and mortality rate of 19%. Patients presenting with upper limb ischemia tend to have significant co-existing disease. Management of upper limb ischemia requires preoperative and/or peroperative angiography with careful application of vascular surgical expertise.
authors.affiliation: Department of Vascular and Endovascular Surgery, St James's Hospital, Trinity College Medical School, James's Street, Dublin 8, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Sultan
authors.forename: D
authors.initials: D
authors.lastname: Evoy
authors.forename: A S
authors.initials: AS
authors.lastname: Eldin
authors.forename: M
authors.initials: M
authors.lastname: Eldeeb
authors.forename: N
authors.initials: N
authors.lastname: Elmehairy
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000792:Angiography; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D017548:Echocardiography, Transesophageal; D004534:Egypt; D004617:Embolism / Q000150:complications; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008877:Middle East; D016019:Survival Analysis; D013901:Thoracic Outlet Syndrome / Q000150:complications; D013927:Thrombosis / Q000150:complications; D014057:Tomography, X-Ray Computed