Acute nontraumatic upper limb ischaemia: A protocol for management

Aim: To determine the role of different modalities available and draw guidelines for the treatment of acute ischaemia of the upper limb. Materials and Method: This is a retrospective study carried out over a period of 7 years between 1994–2000 comparing embolectomy with thrombolytic therapy for upper limb ischaemia. Twenty-two patients presenting with acute upper limb ischaemia admitted in this hospital were studied. Their age, sex distribution, symptoms and associated medical illnesses were documented. Pain was the predominant symptom in most of them. The underlying causes were treated accordingly in the form of excision of cervical rib or high first rib, angioplasty and stenting. Results: The overall success rate was 91% (n = 20) with an amputation rate of 9%. In the surgical group (ten patients), seven patients responded well. Two patients recovered with further thrombolytic therapy. One patient underwent amputation. In the thrombolytic therapy group (ten patients), six patients responded to thrombolytic therapy alone. The rest of them recovered with further embolectomy. Conclusion: Thrombolytic therapy can thus be the first modality of treatment for acute nontraumatic upper limb ischaemia if the limb is viable.