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

## TL;DR

A rare case of upper limb blood flow blockage was successfully treated with a combination of manual clot removal and targeted clot-dissolving therapy in a hospital with limited resources.

## Contribution

Demonstrates successful limb salvage using thrombosuction and catheter-directed thrombolysis in a resource-limited setting.

## Key findings

- Manual thrombosuction followed by catheter-directed thrombolysis restored distal perfusion without complications.
- Pragmatic endovascular approaches can achieve successful outcomes for upper limb ALI in non-tertiary hospitals.
- Cardioembolic upper limb ALI can be effectively managed with tailored interventions despite limited vascular technology.

## Abstract

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.

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.

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.

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