Cardiovascular Journal of Africa: Vol 29 No 2 (March/April 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 88 AFRICA
Upper limb ischaemia: a South African single-centre
experience
Tinus du Toit, Kathryn Manning, Nadraj G Naidoo
Abstract
Objective: The aims of this study were to report on our
experience with upper limb ischaemia (ULI), to define the
pattern and distribution of disease, describe key demographic
features and report on conventional clinical outcomes.
Methods: This was a single-centre, retrospective, descriptive
study. All patients (n = 64) who underwent a surgical inter-
vention for ULI over a 12-year study period were included.
Findings were analysed and compared with the current
literature.
Results: A male:female ratio of 0.60 was reported. Two major
subgroups of patients were identified. The patients in the
thrombo-embolic subgroup (n = 30) were notably younger
than expected (mean age 55 years) compared to those in the
atherosclerotic occlusive disease subgroup (n = 12, mean age
57 years). Presentation overall was generally late, with 8.6%
of acute ULI and 48.3% of chronic ULI patients present-
ing with irreversible ischaemia and tissue loss, respectively.
Thrombo-embolism was the dominant vascular pathology
reported in this case series (47%). Ninety-five procedures
were performed in 64 patients (89 open, six endovascular).
Peri-operative (30-day) mortality rate was 7.8%. Systemic
and procedure-related complications were observed in 13 and
23%, respectively. The overall major amputation rate was
10.9%. Adherence to follow up was poor (51% at six months).
Conclusion: Although few firm conclusions could be drawn,
this review has expanded our overall perspective of ULI,
specific to the population we serve. Collaboration between
African vascular units should be encouraged in an attempt
to further define the pattern of ULI by identifying distinct
geographical confounders.
Keywords: upper limb, acute ischaemia, chronic ischaemia, revas-
cularisation, non-traumatic
Submitted 11/7/17, accepted 7/11/17
Published online 8/12/17
Cardiovasc J Afr 2017; 29: 88–92
DOI: 10.5830/CVJA-2017-049
Upper limb ischaemia (ULI) is a relatively uncommon but well
recognised vascular clinical entity caused by a wide range of
vascular pathologies.1 Upper-limb revascularisation procedures
comprise approximately4%of all vascular procedures performed.2
Contemporary vascular literature has focused predominantly on
vascular occlusive disorders of the lower extremity.
The occupational ramifications and impact on quality of life
in those affected can be substantial, often resulting in loss of
independence and/or livelihood. A thorough understanding of
this condition is essential if significant improvement in surgical
outcome and limb functionality is to be made.
Series that combine acute and chronic ischaemia are rare,
with most publications reporting on either a single clinical (acute
or chronic) or aetiological (traumatic or non-traumatic) aspect
of ULI. The majority of publications originate from developed
countries, with no reports identified from the African continent
to date. Ethnic, demographic and geographic confounders may
influence vascular disease development, necessitating further
investigation rather than extrapolation. Accordingly, we report
on our institutional experience in the context of the current
literature and offer a glimpse into several distinctive features
specific to the population we serve.
Methods
Consecutive patients who underwent a surgical intervention for
ULI over a 12-year period were identified from the Vascular
Unit’s prospectively maintained operative database. Patients
presenting with primary Reynaud’s phenomenon and traumatic
vascular injuries were excluded. The Trauma Unit at our facility
published extensively on this topic within the study period and
duplication of data was a concern.3-5
Qualitative and quantitative data were collected and
appropriately coded to assist data analysis using Stata/SE version
13.1 (StataCorp®, College Station, Texas). Frequencies and
percentages were calculated for categorical data. Means with
minimum and maximum range were calculated for continuous data.
Results
Sixty-four patients presenting with ULI were evaluated and
managed surgically from January 2000 to December 2011. Forty
females (62.5%) with a mean age of 51 years (range 15–84 years)
and 24 males (37.5%) with a mean age of 46 years (range 15–76
years) were included in the study, reflecting a male-to-female
ratio of 0.60 (as opposed to 0.96 in the general Western Cape
population).6 Fig. 1 represents the ethnic distribution within the
study group, in comparison with the general population. 6,7
A wide range of vascular pathologies was identified, with
noticeable demographic differences between groups (Table 1).
A total of 30 patients presented with thrombo-embolic
disease, with all but two patients presenting with acute ULI.
Department of Surgery, Groote Schuur Hospital, Cape
Town, South Africa
Tinus du Toit, MB ChB, FCS (SA), MMed (UCT),
Department of Medicine, Groote Schuur Hospital, Cape
Town, South Africa
Kathryn Manning, BSc, MSc (Med) (UCT)
Vascular Unit, Department of Surgery, Groote Schuur
Hospital, Cape Town, South Africa
Nadraj G Naidoo, MB ChB, FCS (SA)