This protocol addresses acute upper limb ischaemia where the limb is threatened — presenting with motor or sensory loss — or where preserving limb function is critical to the patient's quality of life.
Conservative anticoagulation alone is not recommended when the limb is threatened or when limb function is important to quality of life.
The first-line step — surgical brachial embolectomy under local anaesthesia, with intra-operative completion angiography and systemic anticoagulation — aims to restore visible perfusion and a palpable wrist pulse.
After embolectomy has not fully restored perfusion, the approach moves to endovascular interventions — catheter-based and aspiration techniques — alongside targeted therapies for distal or residual ischaemia. The complete algorithm, indications, and clinical decision points are available in the full structured protocol.
DOI: 10.1016/j.ejvs.2019.09.006
For a patient with acute ischaemia of the upper limb, conservative treatment with anticoagulation alone is not recommended if the arm is threatened, or if limb function is important to quality of life.
Endovascular treatments such as percutaneous thrombectomy, aspiration thrombectomy, or CDT have been used for acute upper limb ischaemia, but only case reports exist to describe their benefits and complications.
Primary distal thrombosis of the hand (or residual distal ischaemia after embolectomy) may benefit from CDT or intravenous prostaglandin therapy.
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