Management of upper extremity peripheral vascular disease: a multimodality approach

Authors

  • Prasad Upganlawar Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
  • Ashwinee Rahalkar Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
  • Sneha Joshi Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
  • Simran Khatri Department of Surgery, Government Medical College, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20202393

Keywords:

Amputation, Embolectomy, Gangrene, Peripheral vascular disease, Upper extremity

Abstract

Background: It is estimated that more than 200 million people suffer from peripheral vascular disease worldwide. However very few studies are available on upper extremity vascular disease, thus making it an under diagnosed and under treated condition.

Methods: In the present study we included 20 participants suffering from upper limb peripheral vascular disease and managed them with multi-modality approach involving general surgeon, interventional radiologist and vascular surgeon for medical line of management, thrombolysis and thrombo-embolectomy procedures.

Results: In the present study we observed that early management of these patients with medical management, interventional radiology and embolectomy procedures helped in limb salvage. However alarmingly high number of patients (35%) landed up in amputation because of low index of suspicion and delayed referral.

Conclusions: A high level of suspicion and early referral to a tertiary care centre where multi-modality facilities like interventional radiology and vascular surgeon are available should be done.

Metrics

Metrics Loading ...

Author Biographies

Prasad Upganlawar, Department of Surgery, Government Medical College, Nagpur, Maharashtra, India

Assistant Professor, Department of General Surgery, Government Medical College, Nagpur, India

Ashwinee Rahalkar, Department of Surgery, Government Medical College, Nagpur, Maharashtra, India

Junior Resident, Department of Surgery, Government Medical College, Nagpur, India

 

Sneha Joshi, Department of Surgery, Government Medical College, Nagpur, Maharashtra, India

Junior Resident, Department of Surgery, Government Medical College, Nagpur, India

Simran Khatri, Department of Surgery, Government Medical College, Nagpur, Maharashtra, India

Junior Resident, Department of Surgery, Government Medical College, Nagpur, India

References

Shu J, Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379-81.

Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg. 1994;220(3):251-68.

Ouriel K, Veith FJ, Sasahara AA. TOPAS Investigators. Thrombolysis or peripheral arterial surgery: phase I results. J Vasc Surg. 1996;23(1):64-75.

Comerota AJ, Gravett MH. Do randomized trials of thrombolysis versus open revascularization still apply to current management: what has changed? Semin Vasc Surg. 2009;22(1):41-6.

Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009;22(1):5-9.

Carlson GA, Hoballah JJ, Sharp WJ. Surgical thrombectomy: current role in thromboembolic occlusions. Tech Vasc Interv Radiol. 2003;6(1):14-21.

Lin PH, Poi MJ, Matos J, Kougias P, Bechara C, Chen C. Arterial disease. Brunicardi FC, Schwartz SI. Schwartz’s principles of surgery. 10th Edition. McGraw-hill; 2014: 890-895.

Cheng CC, Cheema F, Fankhauser G, Silva Jr. MB. Peripheral arterial disease. In: Sabiston textbook of surgery. First South Asia Edition. Elsevier India; 2016: 1754.

Peripheral arterial disease: diagnosis and management, Clinical guideline [CG147], National Institute for health and care excellence guidelines. 2018.

Smith DA, Lilie CJ. Arterial occlusion, acute. In: StatPearls. Treasure Island. StatPearls Publishing; 2019.

Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009;22(1):5-9.

Downloads

Published

2020-05-26

Issue

Section

Original Research Articles