Acute Upper Limb Ischemia: Prompt Surgery and Long-Term Anticoagulation Prevent Limb Loss and Debilitation

Figures & data

Table 1 Patient Demographics, Risk Factors, Antiplatelet/Anticoagulant Medication, Compliance and Medical History

Patient	Age	Gender	Pulse	H/o AF	Cardiac Dis	HTN	Smoker	A/P	A/C	Compliance	Current/Past History
1.	79	F	AF	Yes	–	Yes	Ex	—-	Warfarin	Poor	Previous Embolectomy
2.	79	F	↓	Pacemaker	IHD, BBB	Yes	–	Aspirin	Warfarin	Stopped**	Complete heart block
3.	89	F	AF	Yes	–	Yes	–	—-	—-	—-	Intestinal Obstruction
4.	56	F	AF	Yes	Mitral stenosis	Yes	–	—-	—-	—-	Rheumatic disease
5.	47	F	–	–	Murmur	Yes	–	—-	—-	—-	BMI > 30
6.	58	F	AF	–	–	–	–	—-	—-	—-	Active Malignancy
7.	77	M	–	–	–	Yes	Yes	—-	—-	—-	Stroke, ↑Lipids, Diabetic
8.	43	F	–	–	–	Yes	–	—-	—-	—-	BMI=28, ↑Lipids
9.	55	F	–	Pacemaker	IHD	Yes	–	—-	—-	—-	MI, Stroke, Diabetic
10.	32	M	–	–	–	–	Yes	—-	—-	—-	Hyperthyroid-no Rx
11.	57	M	–	–	IHD	Yes	–	Aspirin	—	—-	ESRD on dialysis
12.	48	F	–	–	–	–	–	Aspirin	—	—-	↑Lipids, DVT
13	39	F	–	–	IHD	Yes	–	Aspirin	—	—-	↑Lipids, OCP
14.	92	F	AF	–	–	–	–	—-	—	—-	↑Lipid, Hypothyroid
15	81	F	AF	Yes	–	Yes	–	—-	Warfarin	Low	AF
16.	77	F	AF	–	–	Yes	–	—-	—-	—-	Stroke

Note: **Stopped due to gastrointestinal bleeding.

Abbreviations: AF, atrial fibrillation; ↓, bradycardia; H/o, History of; Cardiac Dis, cardiac disease; IHD, ischemic heart disease; BBB, bundle branch block; HTN, hypertensive; A/P, antiplatelet drug; A/C, anticoagulant drugs; BMI, body mass index; ↑Lipids, hyperlipidemia; MI, myocardial infarct; ESRD, end stage renal disease; DVT, deep vein thrombosis; OCP, oral contraceptive pill.

Table 2 Clinical Presentation, Arteriotomy, Anesthesia, and Immediate Outcome

Patient	Clinical Presentation					Surgical Intervention
	Pain	Paraesthesia	Cyanosis	Cold	Duration	Arteriotomy	Anesthesia	Outcome
1	–	√	–	√	24 hrs	Longitudinal	GA	Good flow-pulses
2	√	√	–	–	24 hrs	Longitudinal	LA	Good flow-pulses
3	–	√	√	√	12 hrs	Longitudinal	LA	Good flow-pulses
4	√	–	–	√	12–24 hrs	Transverse	BB	Good flow-pulses
5	–	√	–	√	48 hrs	Transverse	LA	Good flow-pulses
6	–	√	√	√	48 hrs	Transverse	LA*	2 re-explorations
7	√	√	√	√	24 hrs	Transverse	LA	Good flow-pulses
8	√	√	√	√	96 hrs	Oblique	LA*	2 re-explorations
9	√	–	√	√	72 hrs	Oblique	LA	Good flow-fasciotomy
10	√	√	√	–	24 hrs	Oblique	LA	Flow-pulses
11	√	√	√	√	8 hrs	Oblique	LA*	Flow-pulses
12	–	√	√	√	120 hrs	Oblique	LA	Good flow-pulses
13	√	√	√	–	24 hrs	Oblique	LA	Good flow-pulses
14	–	√	√	–	24 hrs	Oblique	LA	Good flow-pulses
15	√	–	–	√	24 hrs	Oblique	LA	Good flow-pulses
16	√	√	–	–	24 hrs	Oblique	GA	Good flow-pulses
T	10/16	13/16	10/16	11/16

Abbreviations: LA, local anesthesia; LA*, local anesthesia with sedation; BB, brachial block.

Figure 1 Brachial artery, devoid of blood flow prior to embolectomy.

Figure 2 Filling of the brachial artery showing pre-arteriotomy site (yellow arrow), post-arteriotomy site (blue arrow) and oblique arteriotomy in between, after embolectomy.