Acute Upper Limb Ischemia: A Case of Successful Thrombosuction and Catheter-Directed Thrombolysis in a Resource-Limited Hospital.

BACKGROUND

Acute limb ischemia (ALI) involving the upper limbs is a vascular emergency that represents only 5% to 10% of all ALI cases. Prompt diagnosis and intervention are crucial to prevent irreversible damage, particularly in resource-limited hospitals.

CASE SUMMARY: A 56-year-old woman hospitalized with atrial fibrillation and acute decompensated heart failure developed sudden left upper limb weakness and sensory loss. Bedside Doppler ultrasonography confirmed axillary artery occlusion (Rutherford IIb). Given limited resources, she underwent successful manual thrombosuction followed by catheter-directed thrombolysis with alteplase, restoring distal perfusion without complications.

DISCUSSION: This case illustrates a rare but critical presentation of cardioembolic upper limb ALI. Despite limited vascular technology, a pragmatic endovascular approach led to limb salvage. It highlights the feasibility of guideline-adapted care in nontertiary settings.

TAKE-HOME MESSAGE: Even in hospitals with limited facilities, early recognition and tailored endovascular strategies can yield successful outcomes in upper limb ALI.