Treatment of Acute Upper Limb Arterial Occlusion with a Threatened Limb
This protocol applies to acute upper limb ischaemia where the limb is threatened — presenting with motor or sensory loss — or where upper limb function is important to the patient's quality of life. In these situations, conservative management with anticoagulation alone is not the recommended course of action.
Approach overview partial summary
When compartment syndrome develops following reperfusion, surgical fasciotomy of the forearm is part of the recommended approach. The full protocol details specific indications, technique considerations, and the complete operative guidance.
References
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.
- Prophylactic fasciotomy is seldom indicated, but if the arm has been ischaemic for many hours and swells considerably after successful embolectomy, fasciotomy is indicated.
- If it is indicated, volar fasciotomy is suggested, but concurrent dorsal fasciotomy is also recommended by some authors (Fig. 13).