Therapeutic Outcomes and Thromboembolic Events after Treatment of Acute Arterial Thromboembolism of the Upper Extremity

Background To investigate short- and long-term outcomes of patients with acute arterial thromboembolism of upper extremity, focusing on postoperative thromboembolic events by etiology. Methods Hospital records of 53 patients (average age 70 years; males 49%) with acute arterial thromboembolism of upper extremity treated between June 1993 and December 2013 were retrospectively reviewed, evaluating patient characteristics and clinical outcomes, both short and long term. Subjects were stratified as those with (group I, 34) and without (group II, 19) atrial fibrillation as underlying cause. Results Two patients received anticoagulation alone as conservative treatment. The remainder ( n = 51) underwent surgical revascularization. Symptoms resolved in 51 patients (96%) except 2 patients with postoperative reocclusion, and there was no need of amputation in all patients. Overall inpatient mortality was 5.6% (3/53). Patients of group I suffered most of the recurrent thromboembolic events (group I: 17 events, 14 patients; group II: 2 events, 2 patients) recorded during follow-up (mean duration 56.8 ± 62.2 months). Respective event-free survival rates at 1, 3, and 5 years differed significantly by group: 77%, 44%, and 44% for group I; 100%, 100%, and 83% for group II ( P = 0.004). Among 14 patients with recurrent embolic events in group I, half of the patients were not receiving anticoagulants; however, anticoagulant cessation was generally arbitrary. Overall survival rates at 1, 3, and 5 years were 82%, 69%, and 52% for group I and 84%, 78%, and 70% for group II ( P = 0.21). Conclusions In this study, surgical treatment of acute arterial thromboembolism of upper extremity was largely successful. Especially in patients with atrial fibrillation, adequate long-term anticoagulation is indicated as prophylaxis, given the high rates of recurrent thromboembolic events.