Upper Limb & Thoracic Outlet

Acute upper limb ischaemia is sudden loss of arterial perfusion to the arm, usually from a cardiac embolus in an elderly patient with AF. Compared with the leg, it is more often embolic, less often limb-threatening and less immediately life-threatening, but long-term mortality is high because it marks severe cardiac disease. Decide whether the arm is threatened and whether there is good inflow. Typical embolus + threatened arm + palpable axillary/proximal brachial pulse usually proceeds to brachial embolectomy under local anaesthetic; otherwise image first.