Surgery for acute arterial emboli to the arm

During a 5-year period (1987-1992) we removed under local anesthesia 20 emboli and 2 thrombi from the arms of 18 patients aged 60-90 using a Fogarty catheter. 18 of the emboli (90%) were of cardiac origin. 1 patient had thrombosis of the axillary artery (2 episodes). The occlusions were brachial in 14 (70%), axillary in 5 (25%), and radial in 1. From 1.5 hours to 1 week elapsed between onset of symptoms and operation. 9 patients underwent arteriography. Surgery was successful in 19 (95%). Limb necrosis developed in a patient operated on 1 week after onset of symptoms. Necrosis progressed despite a palpable radial pulse. 33 patients (15%) died of causes unrelated to the operation: 2 had terminal cardiac disease and the third concomitant occlusion of the superior mesenteric artery. Early surgical exploration is advocated for acute arterial embolism of the upper extremity. Ischemic changes may be reversible even later than 24 hours from onset of symptoms. Routine arteriography is not needed before surgical exploration of these cases.