Management of upper extremity arterial disease (2026)
Description
Authors: M. Schoder and M. Cejna
Reviewers: R. Lakshminarayan, C. Loberg, and R. Uberoi
This course corresponds to chapter 2.2.1.1.2 Aortic and upper extremity arterial disease in the European Curriculum and Syllabus for Interventional Radiology.
Abstract
Upper extremity arterial vascular disease is considerably less common than peripheral artery disease of the lower limbs. Compared to leg artery disease, which is usually triggered by atherosclerosis, upper limb ischemia is caused by a wide range of vascular pathologies and may involve the large arteries of the arm or the smaller arteries below the elbow. Knowledge of the pattern and distribution of specific diseases, and appropriate diagnosis and treatment, are essential for prognosis and outcome.
Acute upper limb ischemia is defined as any sudden decrease or worsening of limb perfusion that threatens limb viability, with symptoms lasting less than 14 days. Prompt diagnosis and treatment, either by catheter-based techniques or surgical interventions, is essential to prevent functional impairment and disability. Embolic artery occlusions are the most frequent ischemic events with a cardiac source in 70-95%. Less common causes are vessel thrombosis triggered by different disorders, plaque rupture, dissections and traumatic/iatrogenic injuries.
In chronic ischemic conditions, partially or completely blocked arteries due to atherosclerosis mostly affect the brachiocephalic trunk and subclavian artery. Because of rich collateral circulation, upper-extremity artery disease can be asymptomatic. However, typical clinical symptoms such as exertional arm pain (in analogy to “claudication”) or weakness and/or a subclavian steal syndrome may be present. In a younger age population with ischemic symptoms, it is important to consider rare disorders including vasculitis, fibromuscular dysplasia (FMD) or arterial thoracic outlet syndrome (ATOS).
Learning objectives
- Becoming aware of different disorders which may cause acute and/or acute on chronic and/or chronic ischemic symptoms in upper extremity artery disease
- Being able to assess the patient’s clinical status to differentiate correctly between chronic and acute ischemic symptoms
- Becoming confident with diagnostic tools and including the most suitable imaging for planning of an appropriate therapeutic intervention
- Becoming aware of different percutaneous endovascular techniques (vascular access, diagnostic angiography and recanalization techniques)
- Becoming aware of potential complications and their management and knowing about surgical options and complementary surgical procedures
- Knowing about the post-procedural management and patient care
- Becoming aware of technical and clinical outcomes
Further information
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.1.2 Aortic and upper extremity arterial disease.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around two hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 2 European CME credits (ECMEC).
The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.
The enrolment period of this course is linked to the validity of the All-Access Pass.
Release date: November 2026
