Left upper limb arterial thrombosis on angiography


Color doppler also revealed partial thrombosis of left subclavian artery and complete lack of flow in left axillary, left brachial, left radial and left ulnar artery. Normal flow was seen in left common carotid artery.

In this setting of massive left upper limb arterial thrombosis, the only possibility to save the limb was to perform brachial artery endarterectomy and thrombectomy.

On distal brachial artery endarterectomy and proximal thrombectomy with fogarty catheter, large amount of white thick thrombus was removed from the brachial artery. Significant forward blood flow was established and the artery closed. Patient was put on heparin and antiplatelets.

Next day, the patient developed left posterior circulation infarct. The possibility of an embolus getting logged in left vertebral artery was considered, either during angiography or embolectomy.

Eventually, over the period of one week, the patient developed gangrene of left distal upper limb and eventually had to undergo left upper limb shoulder disarticulation.

It was considered that likely due to some auto immune disease or increased tendency to thrombosis, there was rapid and accelerated re-thrombosis of left upper limb vessels. The possibility of Takayasu's arteritis was considered.