Abstract
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 selfexpanding 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.
Highlights
She was seen at tertiary center 2 months later with continuing pain, swollen palm and immobile fingers but no gangrene
A 68 years old female patient, hypertensive, non-diabetic, under medical treatment for clinically diagnosed Ischaemic Heart disease, had sudden onset acute pain in the right arm with development of pallor of the arm and absence of radial pulse detected by her husband
On hospitalization, previously undiagnosed atrial fibrillation was detected on ECG, and no pulse was available distal to the axillary artery
Summary
She was seen at tertiary center 2 months later with continuing pain, swollen palm and immobile fingers but no gangrene. On hospitalization (district level), previously undiagnosed atrial fibrillation was detected on ECG, and no pulse was available distal to the axillary artery. Clinical diagnosis was thrombo-embolic occlusion of right axillary artery following development of atrial fibrillation of unknown duration. The morning an angiogram was performed from right femoral artery, confirming the clinical diagnosis in addition to a highly tortuous double U-turn subclsvian artery (Figure 1). She was continued on medical management only and discharged after 7 days under Warfarin, reporting significantly improved condition of the arm
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