Acute upper limb ischaemia
Acute upper limb ischaemia (AULI) is a time‑critical reduction in arterial inflow to the arm, hand or digits. It is much less common than lower‑limb acute ischaemia but follows the same principles of rapid assessment, early anticoagulation and urgent vascular input to salvage the limb and reduce systemic complications.
Aetiology and pathophysiology
Most acute upper‑limb arterial occlusions are embolic, with the heart (atrial fibrillation, left ventricular thrombus after myocardial infarction) the common source. Other causes include:
- Thrombotic occlusion on pre‑existing atherosclerotic disease (for example subclavian stenosis).
- Iatrogenic or catheter‑related thrombosis.
- Blunt trauma.
- Arterial dissection.
- Vasospasm.
Emboli commonly lodge in the axillary or brachial arteries; more distal occlusions affect antebrachial or digital vessels.
Clinical features
Onset is typically sudden (minutes-hours) for embolic events; thrombotic occlusions may have a more gradual course.
Typical signs and symptoms:
- Severe pain (often out of proportion to findings).
- Pallor, coolness and delayed capillary refill.
- Absent or reduced distal pulses (brachial, radial, ulnar); use a handheld Doppler to document arterial signals.
- Sensory disturbance and paraesthesia.