Cardiovascular and Interventional Radiological Society of Europe
OnlineCIRSE Academy coursesArterial Intervention - online coursesManagement of upper extremity arterial disease (CME) – online course

Management of upper extremity arterial disease (CME) – online course


Authors: M. Schoder and M. Cejna

Reviewers: R. Lakshminarayan, C. Nice, F. Orsi, S. Spiliopoulos and F. Wolf

This course corresponds to chapter Aortic and upper extremity arterial disease in the European Curriculum and Syllabus for Interventional Radiology.



Upper extremity arterial vascular disease is considerably less common than peripheral artery disease of lower limbs. Compared to leg artery disease, which is usually triggered by atherosclerosis, upper limb ischaemia 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 is essential for prognosis and outcome.
Acute upper limb ischaemia is defined as any sudden decrease or worsening of limb perfusion that threatens limb viability with duration of symptoms of 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 complete blocked arteries due to atherosclerosis affect mostly the level of the brachiocephalic trunk and the subclavian artery. Due to a rich collateral circulation, the upper extremity artery disease can be asymptomatic. However, typical clinical symptoms 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 ischaemic symptoms in upper extremity artery disease
  • Being able to assess the patient’s clinical status to differentiate correctly between chronic and acute ischaemic symptoms
  • Becoming confident with diagnostic tools and include the most suitable imaging for planning of an appropriate therapeutic intervention
  • Becoming aware of different percutaneous endovascular techniques (vascular access, diagnostic angiography and recanalisation 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 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 credit (ECMEC). The CME accreditation for this course will expire on July 12, 2024. A non-CME accredited version of the course will remain available for two more years.

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: July 2022