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Rationale and Objective:
Although the current standard of care for patients with upper extremity acute ischemia is pre-operative angiographic-guided thrombo-embolectomy, at our institution, 59 patients underwent thrombo-embolectomies using pre-operative ultrasound findings as the sole diagnostic imaging method.

Method:
Between May 2000 and December 2009, 59 patients [21 males and 38 females, with a mean age of 74 years, and a range of 42 to 94 years, ± 18 (SD)] underwent upper extremity (UE) thrombo-embolectomies based on pre-operative ultrasound findings. The indications were UE acute ischemia resulting from thrombo-emboli to the brachial (38), ulnar (14), radial (12), or axillary (8) arteries in various combinations. 41 out of 59 patients had a completion angiogram done which demonstrated patent vessels. Follow -up consisted of post-operative upper extremity duplex when clinically indicated,
On-going clinical evaluation, and scheduled clinic visits.

Result:
Mean follow-up was 12 months, ± 23 (SD). A 49% (29 patients) overall mortality resulting from co-morbid conditions (MI=17, ESRD=10, sepsis), and a 30day mortality of 22% (13 patients) were observed. Other co-morbid conditions were as follows: atrial fibrillation (26), congestive heart failure (11), hypertension (30), and diabetes mellitus (16). 3 cases required more than thrombo-embolectomies based upon completion angiography. One had required an immediate brachial-to-radial bypass, while the other two patients required axillary-to-brachial bypass - one performed on post-operative day one, with the other at 9 months, respectively.

Conclusion:
Pre-operative ultrasound and completion angiogram is an effective and safe diagnostic method for the management of acute upper extremity ischemia.