Outcomes of Upper-Extremity Revascularization Following Acute Limb Ischemia.

Purpose: Acute limb ischemia (ALI) is a vascular emergency that demands prompt diagnosis and surgical intervention. This study investigated the incidence, clinical presentation, and outcomes of upper-extremity ALI and examined the impact of patient risk factors on these outcomes.

Methods: A retrospective review of patients who underwent upper-extremity revascularization for ALI at a single health care system from 2003 to 2023 was conducted. Patients with ischemia duration under 14 days were included. Data on demographics, hypercoagulability risk factors, ischemia duration, clinical presentation, etiology, hospitalization length, and complications were analyzed.

Results: Three hundred sixty-six patients underwent revascularization for ALI during the study period. The average age of the patients was 65.0 ± 17.0 years, and 69.7% were women. Common etiologies included embolism from atrial fibrillation (21.5%) and iatrogenic injury (29.3%). The brachial artery was the most common occlusion site (89%). The median ischemia time was 12.0 hours (IQR = 29.2). Pain and paresthesia at initial presentation were considerably associated with increased duration of ischemia. Eighty patients (21.9%) experienced complications. Eleven patients (3%) who received prophylactic fasciotomy had a median ischemia duration of 22 (13-76) hours, which was similar to patients without prophylactic fasciotomy (14 [7-35] hours). Prophylactic fasciotomy was also associated with increased complications.

Conclusions: Upper-extremity ALI revascularization has a high complication rate. Although longer ischemia duration may intensify symptoms, it does not predict complications or hospital stay. Prophylactic fasciotomy, lacking clear benefit, may increase risks, and calls into question its routine use in upper-extremity ALI cases.

Type of study/level of evidence: Prognostic IV.