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A Population-Based Study of Incidence, Presentation, Management and Outcome of Primary Thromboembolic Ischemia in the Upper Extremity

  • Jørgen B. VenneslandEmail author
  • Kjetil Søreide
  • Jan Terje Kvaløy
  • Andreas Reite
  • Morten Vetrhus
Original Scientific Report
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Abstract

Objectives

To investigate the epidemiology of acute upper limb thromboembolism in a well-defined Norwegian population.

Methods

This study was a retrospective, single-center, observational population-based cohort study of acute upper limb thromboembolism. The study included all patients from the hospital’s primary catchment area from January 2000 to December 2015. Age- and gender-adjusted incidence rates were calculated using population demographics from Statistics Norway.

Results

A total of 54 patients were identified, of which 49 were included in the analyses: 27 (55%) females (median age 83 years, range 40–96) and 22 (45%) males (median age 70 years, range 42–95) (P = .053). The adjusted incidence rate for the period was 1.6 patients per 100,000 inhabitants per year (95% confidence interval 1.2–2.2) and did not change significantly during the period studied. Atrial fibrillation was detected by electrocardiography in 30 (61%) patients; in this group, 10 patients were on warfarin but only two had an international normalized ratio > 1.9 and the remaining 20 were not anticoagulated. Altogether, 38 (78%) patients underwent surgery, 1 (2%) was treated with thrombolysis, and the remaining patients were treated conservatively; no amputations were performed. Four patients (8%) died within 30 days, and 12 of the surviving 45 patients (27%) had recurrent thromboembolism.

Conclusion

The incidence rate was stable during the study period. Patients with upper limb thromboembolism due to atrial fibrillation were inadequately anticoagulated. One in four patients experienced a recurrent thromboembolic event. Lifelong anticoagulation should be considered in all patients with upper limb thromboembolism.

Notes

References

  1. 1.
    Eyers P, Earnshaw JJ (1998) Acute non-traumatic arm ischaemia. Br J Surg 85:1340–1346CrossRefGoogle Scholar
  2. 2.
    Andersen LV, Lip GY, Lindholt JS et al (2013) Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs. JTH 11:836–844Google Scholar
  3. 3.
    Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146:857–867CrossRefGoogle Scholar
  4. 4.
    Stonebridge PA, Clason AE, Duncan AJ et al (1989) Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review. Br J Surg 76:515–516CrossRefGoogle Scholar
  5. 5.
    Skeik N, Soo-Hoo SS, Porten BR et al (2015) Arterial embolisms and thrombosis in upper extremity ischemia. Vasc Endovasc Surg 49:100–109CrossRefGoogle Scholar
  6. 6.
    Conte MS, Pomposelli FB, Clair DG et al (2015) Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 61:2s–41sCrossRefGoogle Scholar
  7. 7.
    Aboyans V, Ricco JB, Bartelink MEL et al (2018) Editor’s choice—2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg 55:305–368CrossRefGoogle Scholar
  8. 8.
    Andersen LV, Mortensen LS, Lindholt JS et al (2010) Upper-limb thrombo-embolectomy: national cohort study in Denmark. Eur J Vasc Endovasc Surg 40:628–634CrossRefGoogle Scholar
  9. 9.
    Dryjski M, Swedenborg J (1984) Acute ischemia of the extremities in a metropolitan area during one year. J Cardiovasc Surg 25:518–522Google Scholar
  10. 10.
    Pentti J, Salenius JP, Kuukasjarvi P et al (1995) Outcome of surgical treatment in acute upper limb ischaemia. Ann Chir Gynaecol 84:25–28Google Scholar
  11. 11.
    Andrade J, Khairy P, Dobrev D et al (2014) The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res 114:1453–1468CrossRefGoogle Scholar
  12. 12.
    von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet (London, England) 370:1453–1457CrossRefGoogle Scholar
  13. 13.
    Reite A, Soreide K, Ellingsen CL et al (2015) Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality. J Vasc Surg 61:1168–1174CrossRefGoogle Scholar
  14. 14.
    Sandvik OM, Soreide K, Gudlaugsson E et al (2016) Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria. Br J Surg 103:226–232CrossRefGoogle Scholar
  15. 15.
    Lip GY, Nieuwlaat R, Pisters R et al (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137:263–272CrossRefGoogle Scholar
  16. 16.
    R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. Accessed 4 Dec 2017.
  17. 17.
    Pohar M, Stare J (2006) Relative survival analysis in R. Comput Methods Programs Biomed 81:272–278CrossRefGoogle Scholar
  18. 18.
    Aragon TJ (2017) epitools: epidemiology tools. R package version 0.5-10. https://CRAN.R-project.org/package=epitools. Accessed 4 Dec 2017.
  19. 19.
    Schmidt M, Ulrichsen SP, Pedersen L et al (2016) 30-year nationwide trends in incidence of atrial fibrillation in Denmark and associated 5-year risk of heart failure, stroke, and death. Int J Cardiol 225:30–36CrossRefGoogle Scholar
  20. 20.
    Lasota AN, Overvad K, Eriksen HH et al (2017) Validity of peripheral arterial disease diagnoses in the Danish National Patient Registry. Eur J Vasc Endovasc Surg 53:679–685CrossRefGoogle Scholar
  21. 21.
    Ljungman C, Adami HO, Bergqvist D et al (1991) Time trends in incidence rates of acute, non-traumatic extremity ischaemia: a population-based study during a 19-year period. Br J Surg 78:857–860CrossRefGoogle Scholar
  22. 22.
    Andersson T, Magnuson A, Bryngelsson IL et al (2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J 34:1061–1067CrossRefGoogle Scholar
  23. 23.
    Kim HK, Jung H, Cho J et al (2015) Therapeutic outcomes and thromboembolic events after treatment of acute arterial thromboembolism of the upper extremity. Ann Vasc Surg 29:303–310CrossRefGoogle Scholar
  24. 24.
    Srebenik HH, Circulation Collateral (2002) In: Srebenik HH (ed) Concepts in anatomy. Springer, Boston, pp 201–206CrossRefGoogle Scholar
  25. 25.
    Wong VW, Major MR, Higgins JP (2016) Nonoperative management of acute upper limb ischemia. Hand (New York, NY) 11:131–143CrossRefGoogle Scholar
  26. 26.
    Fuster V, Ryden LE, Asinger RW et al (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J 22:1852–1923CrossRefGoogle Scholar
  27. 27.
    Pisters R, Lane DA, Nieuwlaat R et al (2010) A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–1100CrossRefGoogle Scholar
  28. 28.
    Bruins Slot KM, Berge E (2018) Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation. Cochrane Database Syst Rev 3:CD008980Google Scholar
  29. 29.
    Zirlik A, Bode C (2017) Vitamin K antagonists: relative strengths and weaknesses vs. direct oral anticoagulants for stroke prevention in patients with atrial fibrillation. J Thromb Thrombolysis 43:365–379CrossRefGoogle Scholar
  30. 30.
    Deguara J, Ali T, Modarai B et al (2005) Upper limb ischemia: 20 years experience from a single center. Vascular 13:84–91CrossRefGoogle Scholar
  31. 31.
    Kronzon I, Saric M (2010) Cholesterol embolization syndrome. Circulation 122:631–641CrossRefGoogle Scholar
  32. 32.
    Maino A, Rosendaal FR, Algra A et al (2015) hypercoagulability is a stronger risk factor for ischaemic stroke than for myocardial infarction: a systematic review. PLoS ONE 10:e0133523CrossRefGoogle Scholar
  33. 33.
    Giacalone G, Abbas MA, Corea F (2010) Prevention strategies for cardioembolic stroke: present and future perspectives. Open Neurol J 4:56–63Google Scholar
  34. 34.
    Hiratzka LF, Bakris GL, Beckman JA et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121:e266–e369Google Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Jørgen B. Vennesland
    • 1
    Email author
  • Kjetil Søreide
    • 2
    • 3
    • 4
  • Jan Terje Kvaløy
    • 5
    • 6
  • Andreas Reite
    • 1
  • Morten Vetrhus
    • 1
  1. 1.Department of Surgery, Vascular Surgery UnitStavanger University HospitalStavangerNorway
  2. 2.Department of Gastrointestinal SurgeryStavanger University HospitalStavangerNorway
  3. 3.University of BergenBergenNorway
  4. 4.Clinical MedicineUniversity of BergenBergenNorway
  5. 5.Research DepartmentStavanger University HospitalStavangerNorway
  6. 6.Department of Mathematics and PhysicsUniversity of StavangerStavangerNorway

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