A study of upper limb ischemia.

Saravanan, B (2013) A study of upper limb ischemia. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Arterial diseases of the upper limb are relatively rare in comparison with those of the lower limb. A large number of diseases can affect the arterial tree of upper limb. Upper extremity vascular reconstruction is much less common than the lower limb and it accounts for less than 5% of patients with upper limb ischemia. The good collateral around the elbow and shoulder explains the reason why most of the chronic occlusive diseases are asymptomatic. Upper extremity vascular diseases can be classified based on anatomic location or on the basis of etiology. The age distribution of patients is also broad with atherosclerotic affecting the older people and autoimmune affects the younger age group. Occlusive disease can affect both the larger and smaller arteries. Subclavian is the most common larger artery involved in upper limb due to atherosclerosis whereas smaller vessels are involved most frequently due to arteritis. Aneurysms of the upper limb arterial tree are rare and may present with ischemia due to emboli and thrombosis. Previous publications suggest that conservative management of patients with acute arm ischemia results in functional limb impairment in up to three-quarters of patients managed in this way and is therefore not advocated. Our study deals with the various modalities and surgical techniques and its outcome that are commonly employed for revascularization of the upper limb include, thromboembolectomy, primary arterial repair with or without patch angioplasty, and autologous or venous bypass grafting. These may occasionally be combined with concomitant cervical sympathectomy or cervical rib excision. AIM : The purpose of this study was to review the factors that will influence the outcome of upperlimb bypass and to identify those factors that are modifiable, and will help in improving the outcome of the procedures, improve the patency of the graft and limb salvage rate. CONCLUSION : Though incidence is less, the upper limb critical ischemia can result in severe functional impairment and disability. Presentation of critical limb ischemia of upper limb results in functional loss than compared to lower limb ischemia because of damage to collaterals hence early revascularisation is essential. CT or MR Angiogram provides adequate information to plan for revascularisation in upper limb ischemia and this obviates the need for Digital subtraction angiography which is invasive with more procedural complications. In the presence of proximal artery occlusion like subclavian, axillary Ipsilateral carotid serves as a good donor vessel, thus obviating the need for cross over from opposite side. Though it is a uncommon entity detailed history taking, physical examination with prompt recognition of upper limb ischaemia and active approach to management in the form of Angiogram and Revascularisation procedures are crucial in obtaining a good outcome and reducing the risk of late disabling effects . The principle of revascularisation is to preserve the limb if not possible to preserve maximum length for effective fixing of prosthesis. Distal bypass to radial or ulnar artery are equally effective as compared to lower limb Patency rate of 94% for upper limb bypass irrespective of the etiology. Early intervention results in good functional limb.

Item Type: Thesis (Masters)
Uncontrolled Keywords: upper limb ischemia.
Subjects: MEDICAL > Vascular Surgery
Depositing User: Kambaraman B
Date Deposited: 24 Jul 2017 03:58
Last Modified: 24 Jul 2017 03:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/2076

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