Management of Acute Nontraumatic Upper Limb Ischemia
Autor: | Mohamed Baguneid, Dominic Dodd, Paul Fulford, Yiannis Hadjilucas, Motassim Bukhari, Gareth Griffiths, Nicholas Chalmers, Michael Walker, M.G. Walker |
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Rok vydání: | 1999 |
Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Ischemia Embolectomy 030204 cardiovascular system & hematology Amputation Surgical Electrocardiography 03 medical and health sciences 0302 clinical medicine medicine.artery medicine Humans Thrombolytic Therapy 030212 general & internal medicine Subclavian artery Aged medicine.diagnostic_test Heparin business.industry Patient Selection Angiography Thrombolysis Middle Aged Vascular surgery medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Amputation Echocardiography Anesthesia Acute Disease Streptolysins Arm Upper limb Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Angiology. 50:715-720 |
ISSN: | 1940-1574 0003-3197 |
Popis: | A retrospective review of all patients presenting to a tertiary referral center with acute nontraumatic upper limb ischemia between January 1992 and June 1997 was under taken to examine the role of intraarterial thrombolysis in the management of such cases. Twenty-one patients were identified in the radiology and vascular surgery departments' registers. Twenty (95%) underwent angiography, demonstrating subclavian artery occlusion in four, axillary in two, brachial in 13, and one at the digital level. Intraarterial thrombolysis was attempted in 12 patients. There were three technical failures, all requiring embolectomy. Six had complete lysis and resolution of their symptoms. One patient had partial lysis but experienced no further rest pain. Thrombolysis was unsuc cessful in two cases with one subsequently requiring embolectomy and the other surgical bypass. Three patients had surgical intervention as their primary procedure with two favorable outcomes and one ending in above-elbow amputation. Five patients were treated conservatively with heparin, resulting in three partial and two full recoveries. One patient experienced complete resolution of symptoms with an intravenous prosta cyclin infusion. Both electrocardiograms (ECG) and echocardiograms (ECHO) were of limited diagnostic aid, and long-term warfarin anticoagulation was prescribed to all patients. There was no recurrence of upper limb ischemia at a median follow up of 18 months. Intraarterial thrombolysis is an effective first line treatment for acute nontrau matic upper limb ischemia in selected cases. |
Databáze: | OpenAIRE |
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