Mx of non traumatic ALI of upper limb

Epidemiology - <5% of limb ischaemia

Causes – Embolic, rarely thrombotic (due to low incidence of PVD in UL),
Vasculitis, CTD (scleroderma, SLE, RA), Burger’s disease, type A aortic dissection,
subclavian steal syndrome, axillary radiotherapy, AVF – steal syndrome, AVM
Origin of embolus – mural thrombus, paradoxical thrombus, cervical rib,
subclavian aneurysm, thoracic outlet syndrome
Diagnosis – clinical – 6Ps, hx of Raynaud’s phenomenon, signs and symptoms of
underlying cause
Examination – contralateral pulse, cardiac signs (AF, murmurs)
Rutherford classification
Radiological – duplex, angiography, CTA, MRA
2D Echo
Management – acute – systemic anticoagulation
Analgesics
Rehydration, bed rest
Mx of arrythmias
Definitive – Embolectomy in embolic cause, catheter directed
thrombolysis
Other – definitive management of underlying causes
PGE1
Amputation (as a last resort)
Follow-up – lifelong warfarin is indicated
Rehabilitation