Acute Upper Limb Ischaemia: A 5-Year Prospective Single-Centre Experience from Northern Morocco

Acute upper limb ischaemia (AULI) is an uncommon vascular emergency associated with a risk of limb loss and functional impairment. Contemporary data from North Africa remain scarce. This study aimed to evaluate the clinical characteristics, aetiological factors, management strategies, and outcomes of patients presenting with AULI in a tertiary vascular centre in Northern Morocco.

A prospective observational cohort study was conducted including consecutive patients treated for acute non-traumatic upper limb ischaemia between January 2021 and May 2026. Demographic characteristics, comorbidities, clinical presentation, imaging findings, aetiology, treatment strategies, and outcomes were prospectively recorded. The primary outcome was limb loss. Secondary outcomes included clinical improvement, reintervention, and mortality. All outcomes were assessed during the index hospitalisation and up to one month after discharge.

Forty-three patients were included (mean age 59.8 +/- 13.2 years; 76.7% women). Delayed presentation was common, with 53.5% of patients presenting more than 24 hours after symptom onset and 39.6% presenting after more than 72 hours. Rutherford class IIb and III ischaemia accounted for 41.9% and 11.6% of cases, respectively. Cardioembolic disease was the leading aetiology (34.9%), while cancer-associated thrombosis and thrombophilic or inflammatory disorders were important non-cardioembolic causes. The brachial artery was the most frequently involved vessel (74.4%). Thromboembolectomy was performed in 72.1% of patients. Clinical improvement was achieved in 81.4% of cases. Secondary intervention was required in 7.0%. Overall limb loss occurred in four patients (9.3%), and one patient died (2.3%). Rutherford III ischaemia was significantly associated with limb loss.

AULI in Northern Morocco is characterised by delayed presentation, advanced ischaemic severity, and a substantial burden of cancer-associated and thrombophilic disorders. Despite these challenges, surgical thromboembolectomy achieved satisfactory limb-salvage and functional outcomes. Early recognition and prompt referral remain essential to prevent irreversible ischaemic injury.