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Endovascular Therapy of Critical Upper Limb Ischaemia, Performed Two Months after Thromb-Embolic Occlusion of Axillary to Brachial Artery

Ashok Dhar

Thrombo-embolic occlusion of the arterial circulation of upper limb, if not optimally treated by surgical or endovascular approach, can cause ischaemic damage of muscles, potentially leading to gangrene and subsequent loss of affected limb.

68 yrs old female, reported to a local hospital with severe pain and pallor of the right arm. Clinical examination and Duplex revealed total loss of arterial circulation from axilla to palm. ECG showed previously unknown Atrial Fibrillation. Angiogram performed via femoral approach confirmed occlusion of axillary artery at the level of neck of humerus. Medical management with anticoagulation and analgesic was provided and discharged under Warfarin on the 7th day, reported to have improved clinically.

She was seen at tertiary center 2 months later with continuing pain, swollen palm and immobile fingers but no gangrene. Interventional procedure was performed using radial artery approach. The entire occluded segment extending from axillary to mid brachial level was reconstructed by balloon dilatation followed by deployment of self-expanding stents, restoring circulation up to the palm.

Clinical follow up till nine months after procedure showed optimum improvement with good return of muscle power. Duplex showed well patent stented segment. Due to Atrial Fibrillation, she was now under treatment with Dabigatran along with Clopidogrel and Cilostazol.