Medicine (Baltimore). 2025 Dec 12;104(50):e46515. doi: 10.1097/MD.0000000000046515.
ABSTRACT
RATIONALE: Acute limb ischemia is a vascular emergency that occurs when blood flow to a limb suddenly decreases, putting the limb at risk if not treated promptly. Acute limb ischemia accounts for 11% of all vascular emergencies, among which arm ischemia is relatively rare. It is caused by occlusion of the brachial artery, most commonly by vascular thromboembolism. We report a female patient with left upper limb ischemia induced by occlusion of the brachial artery.
PATIENT CONCERNS: We report a 45-year-old female who presents with an acute onset of severe pain, numbness, and pallor in her left arm. Pulse was absent, and muscle power was decreased on physical examination. The patient's past medical history was significant for chronic hypertension controlled with medication.
DIAGNOSES: The diagnosis of acute left arm ischemia was confirmed based on the history of hypertension and Doppler ultrasound, which showed occlusion of the left brachial artery due to atherosclerotic changes.
INTERVENTIONS: The patient was initially treated with heparin and analgesics for pain control. Embolectomy was performed under local anesthesia, and a proximal longitudinal incision was made. The brachial artery was exposed, the proximal artery was clipped, the radial and ulnar arteries were cleared using a Fogarty balloon catheter, and the arteriotomy was closed with Prolene 6/0. Hemostasis was secured, and the skin was closed with Prolene 3/0. The patient was given Augmentin 1-g tablet "Quaque Die" means once daily (QD), heparin injection QD, Tonoflex P injection QD, and Loprin 75-mg tablet QD.
OUTCOMES: During the 8-week follow-up period, all patient symptoms improved. The peripheral pulse was present; there were no paresthesia or numbness, except for mild pain in her left thumb due to ischemia. This was a postoperative complication due to the lodging of an embolic fragment from surgery.
LESSONS: Early diagnosis and prompt surgical intervention in brachial artery occlusion are essential to prevent complications such as gangrene, even in patients without overt vascular risk factors.
PMID:41398884 | PMC:PMC12708205 | DOI:10.1097/MD.0000000000046515