A 42-year-old woman was admitted to the hospital with pain in her left hand for several days. Her left hand was slightly colder than the right. Tests showed normal results except for elevated blood sugar. Ultrasound found normal blood flow with no evidence of blood clots. Angiography revealed a blood clot in the subclavian artery. Risk factors for arterial clots in the upper limbs include age, female sex, atrial fibrillation, hypertension, diabetes, heart attack, heart failure, and stroke. The patient was diagnosed with thromboembolic disease in her left upper limb and would benefit from immediate anticoagulation and surgery to remove the clot from her brachial artery.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Upper Limb Ischaemia due
to Thrombo-embolism
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 A 42-years old lady was admitted to
Sulaymaniyah Teaching Hospital,
Sulaymaniyah, Region of Kurdistan,
Iraq on 14th of September 2009
because of pain in left hand of
several days duration. The left hand
was slightly colder than the right.
Unfortunately, the state of the
pulses of the left upper limb was
not documented in the medical file.
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Courtesy of Prof. Abdulsalam Y Taha

4. The Case…
 CXR, ECG, blood urea and serum
creatinine were normal but her
random blood sugar was elevated
(280 mg/dL).
 Color Doppler ultrasonography
revealed a normal arterial blood
flow and no evidence of deep vein
thrombosis.
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5. 5
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6. 6
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Courtesy of Prof. Abdulsalam Y Taha

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11. Selective left
subclavian
arteriography
revealed a
clot in the
subclavian
artery
11
. Abdulsalam Y Taha
Courtesy of Prof. Abdulsalam Y Taha

12. Axillary
arteriogram was
normal apart
from extensive
collaterals
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Courtesy of Prof. Abdulsalam Y Taha

13. Similarly, the
brachial
arteriogram
was normal
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Courtesy of Prof. Abdulsalam Y Taha

14. Extensive
collaterals in
the forearm
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15. Comment
The clinical and angiographic
findings in this patient were in
favor of subacute to chronic
arterial thromboembolic disease
of the left upper limb. She
could benefit from immediate
anticoagulation and left brachial
embolectomy.
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16. Comment…
 “Major thromboembolism of the limbs is
usually easy to diagnose. It is associated
with some or all of the symptoms of sudden
limb ischemia: pulselessness, pain, pallor,
paresthesia, paralysis, and poikilothermia.
Upper limb thromboembolism is not as
common as that of the lower limb. Lower
limbs are approximately four times more
commonly affected. This may be explained
by atherosclerosis being more prevalent in
the lower limbs” [1].
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17. Comment…
 “Age, female sex, atrial fibrillation,
hypertension, diabetes, myocardial
infarction, heart failure and stroke are
most common risk factors for arterial
thromboembolism of the upper limb”
[1].
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18. ● Bibliography
[1] Andersen LV, Lip GY, Lindholt JS,
Frost L. Upper limb arterial
thromboembolism: a systematic
review on incidence, risk factors, and
prognosis, including a meta-analysis
of risk-modifying drugs. J Thromb
Haemost. 2013 May;11(5):836-44. doi:
10.1111/jth.12181. PMID: 23433284.
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