Upper Limb Ischemia


Plaque buildup in the arteries(called atherosclerosis) that carry blood to your head, organs, and limbs

Plaque is made up of fat, cholesterol, calcium, fibrous tissue can harden and narrow the arteries

Limits the flow of oxygen-rich blood from your heart to your hands, legs, head, kidneys and stomach

Here we will here focus on P.A.D. that affects blood flow to the hands.

Less common than Lower Limb Disease due to the arms’ closer proximity to the heart, and the fact that most patients are asymptomatic


  1. Smoking
  2. Diabetes
  3. High amounts of certain fats and cholesterol in the blood
  4. Tobacco usage in any form
  5. High blood pressure
  6. Inherent blood clotting issues
  7. Old age
  8. Obesity
  9. Thoracic Outlet syndrome
  10. Raynauds syndrome
  11. Idiopathic(unknown)

Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site


Acute- Sudden block of the blood vessels causing immediate threat to the hand

High risk of amputation

Needs urgent treatment

Chronic- Gradual decrease in blood flow

Needs treatment of underlying cause


Associated health issues

P.A.D. increases your risk of coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”)

Clinical Features

  1. Weak or absent pulses in the hands
  2. Intermittent Claudication- symptoms when using the arms and forearms for work which may include pain, numbness, aching, or heaviness in the muscles. Symptoms also may include cramping in the affected side
  3. Pain in the finger tips even at rest
  4. Sores or wounds on the fingers that heal slowly, poorly, or not at all
  5. Gangrene (tissue death)- black color change of skin and tissue
  6. Infected wounds
  7. A pale or bluish color to the skin
  8. A lower temperature in one hand compared to the other hand

Diagnostic Tests

  1. Doppler Ultrasound
  2. Stress position tests
  3. X-rays of neck to see bony abnormalities
  4. Computerised Tomographic Angiogram (CT Scan)
  5. Magnetic Resonance Angiogram (MRI Scan)
  6. Angiogram


Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.

Overall goals- improving symptoms and quality of life, ; reducing symptoms of claudication, reduce infection, heal wounds, reducing risk of heart attack, kidney failure and stroke

Target of treatment in Claudicants- improve painfree period

Target of treatment in individuals with wounds/gangrene- remove dead tissue, heal the wound and preserve healthy tissue

Healthy Lifestyle Changes

  • Physical activity
  • Quitting smoking
  • Heart-healthy eating

Treatment options

Bypass Grafting/Embolectomy Surgery- open surgery