الفهرس 
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Abstract
Q
Acute ischemia of the upper limb occurs much less frequently than in the lower limb. The relative
infrequency of this problem together with confusion about some entities causing upper limb
ischemia presents a challenging problem. Arm ischemia seriously jeopardizes the livehood and
independence of the patient involved.
This study was carried on thirty patients with end stage renal disease. The 30 patients were 19
males and II females, the age of those patients ranged from 4 years to 70 years with a mean age of
37±17.8924 years
All of the patients in the present study were subjected to the following:
A) History Taking:
oPresent history, personal history and special habits.. oPast history especially : trauma, Drugs,
cardiac disease,
DM, Collagen diseases, hypertension,
B) Examination:
I) General Examination.
2) Systemic Examination:
• Especially Heart:
Valvular heart diseases. Cardiomyopathy Ischemic heart diseases Arrhythmias.
3) Local examination of the limb:
C) Investigations:
I. Laboratory routine investigations.
2. Hand held Doppler.
3. Color duplex ultrasound.
4. Angiography when indicated.
The aetiology of acute upper limb ischemia was trauma in I2 (40%) patients, embolism in 7 (23.3%)
patients, thrombosis in 6 (20%) patients, and intra-arterial injection in 3 (I0%) patients while
arteritis was the aetiology of acute upper limb ischemia in 2 (6.7%) patients.
IS patients (50%) of the studied group had no comorbid conditions, five patients (I 6.7%) were
cardiac patients, one patient (3.3%) was diabetic, one patient (3.3%) was hypertensive, one patient
(3.3%) was diabetic and hypertensive, one patient (3.3%) was asthmatic, two patients (6.6%) of the
studied group had collagenic diseases ”Poly Arteritis Nodosa and Pemphegus”, one patient (3.3%) was
drug addict and one patient (3.3%) was comatosed.
Pain was the main symptom experienized by 29 (96.7%) patient as the remaining patient (3.3%) was
comatosed.
Numbness was experienized by I9 (63.3%) patients, pallor by
IO (33.3%), parasthesia by 11 (36.7%) while coldness of the skin was present in 21 (70%) patients.
Palpitation was an associated symptom in 3 (10%) patients.
Motor power was not affected in 6 (20%) patients, diminished in 18 (60%) patients, while it could
not be assessed in 6 (20%) due to the presence of fractures, nerve injuries or in a comatosed
patient.
Among the trauma patients all the patients needed surgical intervention; four (13.3%) patients of
the twelve underwent direct repair (end to end anastomosis) of the injured vessel.
Three of them were in the brachial artery and one patient had direct repair of radial and ulnar
arteries.
Six (20%) patients of the trauma patients had a contused segment of the brachial artery and they
needed an interposition venous graft. Five of them passed smooth post operatively with limb salvage
with a palpable distal pulse while one patient developed secondary haemorrhage which needed
exploration and graft ligation. One (3.3%) of the trauma patients underwent thrombendarterectomy
of the axillary artery intimal fixation following contusion with thrombosis of
. the artery after blunt trauma with fracture glenoid cavity.
Brachial artery embolectomy was done to all patients of embolic acute upper limb ischemia. It
was followed by a smooth postoperative period with palpable distal pulsations.
Thrombotic acute upper limb ischemia occurred in 6 patients,
.,
five of these six patients underwent brachial thrombectomy resulted in
palpable distal pulses.
Two of these five patients passed smooth post operatively with a palpable distal pulse, while in
three patients re-thrombosis occurred and redo of thrombectomy was indicated which resulted m no
improvement and an above elbow amputation was indicated.
The sixth patient of thrombotic acute upper limb ischemia
presented late with gangrene of the thumb and index finger and a critically ischemic medial three
fingers, brachial, radial and ulnar thrombectomy were done with cervical sympathectomy followed by
intra-arterial thrombolytic therapy
Three (10%) patients presented with acute upper limb ischemia due to intra arterial injection. Two
of them underwent ipsilateral cervical sympathectomy which was followed by improvement in one
patient while compartmental syndrome appeared in the other one which was presented lately and
needed forearm fasciotomy and ended by an above elbow amputation.
Two (6.7%) patients of the studied group presented with acute upper limb ischemia due to arteritis.
These two patients underwent brachial thrombectomy. Re-occlusion occurred in the two patients which
indicated redo of thrombectomy. One patient of these two passed smooth post operatively with no
palpable distal pulses, while the other patient ended by an above elbow amputation.
Twenty (66.7%) patients of the studied group passed post
operatively with limb salvage with palpable distal pulses. While two (6.7%) patients passed with a
viable limb with no palpable distal pulses. One (3.3%) patient passed with a viable limb with a
deformity, one (3.3%) patient with thumb amputation. And six (20%) patients passed with an above
elbow amputation.
E) Follow up:
All patients will be followed up for a period at one month post operatively as regard appearance of
complications and limb salvage with and without distal pulsation.
During the follow up period after one month there were· 22 (73.3%) patients free as regard limb
salvage with a functioning upper limb, in one (3.3%) patient the distal pulse disappeared, and
seven (23.3%) patients did not come for follow up as they had above elbow amputation (six patients)
and thumb amputation (one patient).
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