Introduction: This paper reviews the epidemiology, aetiology and management of upper limb ischaemia in a series of 8 patients presenting to a tertiary referral centre over a 4-year period and the review of the pertinent literature. Materials and Methods: Details of patients admitted to Tan Tock Seng Hospital (TTSH) due to critical ischaemia of the upper limbs were obtained from admission summaries through the Computerised Patient Support System (CPSS) and operative notes through LOTUS. Results: There were 8 patients who presented with upper limb ischaemia excluding trauma and iatrogenic causes over the last 4 years. All patients underwent embolectomy. One patient had an amputation post-embolectomy. Our short-term results were encouraging with 7 patients who were well enough to be discharged. One patient had a massive brainstem stroke and was discharged home for comfort care at the request of the family. Conclusion: Careful physical examination and history taking, prompt recognition of upper limb ischaemia and active approach to management in the form of embolectomy are crucial in obtaining a good outcome and reducing the risk of late disabling effects.
Upper limb ischaemia is an uncommon entity which presents less commonly as compared to lower limb ischaemia, and has a wide range of aetiology and controversies in preoperative investigations and management. Less than 2% of patients with upper limb ischaemia presents with rest pain, gangrene or ulcer.1 Although upper limb loss is less as compared to lower limb, it can result in severe functional impairment and disability if there should be any delay in diagnosis and treatment.
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