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Vascular disease of the upper limb 

Vascular disease of the upper limb
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date: 20 September 2019

Acute upper limb ischaemia (AULI) is rare, accounting for only around 17% of all acute extremity ischaemia. Thromboembolism underlies the majority of cases of AULI, the most common source being cardiac thrombus and the most common site the brachial artery. Trauma is responsible for a further quarter of all cases. The rich collateral networks that characterize the upper extremity vasculature mean that it is uncommon for limbs to be threatened or non-viable at presentation. Diagnosis of AULI is largely based on clinical findings, although vascular imaging with duplex ultrasound and angiography may be helpful, in some instances in order to delineate the site of occlusion and determine collateral vasculature. There is debate as to whether surgical intervention is mandated in all patients with AULI, particularly in cases where the arm is ischaemic, but viable. Conservative therapy, with anticoagulation, hydration, and treatment of underlying medical conditions, is advocated by some, while others believe that revascularization is obligatory, given that studies suggest that conservative therapy results in claudication in the majority of patients. Embolectomy for AULI has good outcomes in terms of limb function, but long-term mortality rates are high. Endovascular treatments are reported, although small patient numbers make comparisons with other procedures difficult.

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