Systematic review of the operative and non-operative management of acute upper limb ischemia

Abstract

Acute upper limb ischaemia (AULI) can be managed surgically, via interventional radiology, and conservatively, but no real guidelines exist for when a conservative approach is appropriate. A systematic review of the literature is presented of the surgical, radiological and conservative management of AULI. A search was performed using the electronic databases Medline and Embase. Interventions and outcomes for each study were recorded. The consensus from the literature review was that operative management (embolectomy) is the most commonly used and best first-line treatment for AULI. No studies that used conservative anticoagulation management as a primary therapy, this mainly being reserved for patients deemed unfit for interventional treatment, appear in the literature. The consensus from the literature is that operative management is the most commonly used and best treatment. However, bias toward using operative management for the fittest patients appears in the literature. It is also possible that conservative management is underreported.