Acute Arm Ischaemia

Common Sites of Occlusion

Arm ischaemia accounts for about 20% of all limb ischaemia and is usually due to cardiac emboli since atherosclerosis does not usually affect upper limb vessels [15]. More rarely it can be attributed to emboli from a subclavian artery stenosis, vasculitis and thoracic outlet syndrome.

Patients with upper limb ischaemia without neuromuscular impairment can be admitted and heparinised overnight. Patients with signs of sensorimotor impairment should proceed to surgery. This will usually consist of a brachial embolectomy which can be performed under local anaesthesia.  However, occasionally more extensive procedures are required.

The initial management follows the same principles as for the acutely ischaemic leg: oxygen, analgesia and IV heparin. The patient should then be referred to a vascular specialist.

The MRA demonstrates emboli to the left hand, causing loss of the digital arteries to the lateral aspect of the index and middle fingers and the medial aspect of the ring and little fingers. This presented with cool, pale 4th and 5th fingers.