Clinical Profile and Outcome Predictors in Acute Upper Limb Ischemia: A Retrospective Study from a Tertiary Center in South India

Background: Acute upper limb ischemia (AULI) is an uncommon but time-sensitive vascular emergency. This study evaluates clinical characteristics, etiological spectrum, treatment modalities, and prognostic indicators influencing outcomes in AULI. Methods: This retrospective cohort study included consecutive patients presenting with AULI to a tertiary care center in South India between July 2022 and April 2024. Demographics, comorbidities, ischemia severity (Society for Vascular Surgery SVS classification), treatment approaches, and outcomes were analyzed. Associations between symptom duration, serum creatine kinase (CK) levels, and outcomes were statistically assessed. Results: Fifty-three patients were included (mean age 47.4 years; 58.5% male). The right upper limb was affected in 54.7%. Hypertension (52.8%) was the most common comorbidity. A definite etiology was identified in 47.2% of cases, most commonly hypercoagulable states (18.6%), whereas 52.8% were idiopathic. Based on SVS classification, 17% had Class I, 54.7% Class IIA, and 28.3% Class IIB ischemia. Medical management was offered to 71.7%, with good outcomes in 86.8%. Surgical embolectomy was performed in 26.4%, with 78.6% success. Presentation within 6 h was significantly associated with favorable outcomes ( P = 0.028; odds ratio 5.8, 95% confidence interval: 1.1–30.2). Serum CK levels were not significantly correlated with outcomes ( P = 0.67). No perioperative mortality was observed. Conclusion: Early presentation within 6 h is a strong predictor of favourable outcomes in AULI. CK levels do not correlate with recovery. Conservative management is effective in early or mild ischemia, whereas timely surgery is crucial in advanced cases.