The role of intraoperative angiography in arterial thromboembolectomy for non-traumatic acute upper limb ischaemia

Abstract

The aim of the study was to investigate the influence of intraoperative arteriography on the outcome of upper limb acute arterial thromboembolectomy. In a retrospective study, 63 thromboembolectomies were analysed in 59 patients with acute ischaemia of the upper limbs (51 embolectomies and 12 thrombectomies). In 19 interventions, intraoperative angiography was performed either routinely or because of difficulty in passing the Fogarty catheter and/or absence of backflow. No angiography was performed in 44 interventions because the surgeons were dubious as to the benefits of the procedure. In 6/19 cases (32%) intraoperative angiography led to an extension of the intervention, with 1 intraoperative transluminal angioplasty, 2 patchplasties, 4 distal thromboembolectomies and 2 thromboendarterectomies. In patients with embolic occlusion, the adoption of routine intraoperative angiography resulted in a significantly lower re-occlusion rate at 6 months in comparison with patients who were not submitted to angiography (P<0.05). Also in patients with thrombotic occlusion, the adoption of angiography resulted in a lower re-occlusion rate at 6 months compared to patients not submitted to angiography (P<0.05). There were no amputations at 1 month. We recommend intraoperative arteriography as a routine procedure due to its positive influence on the outcome of thromboembolectomy for acute upper limb ischaemia.