Skip to main content Skip to main navigation menu Skip to site footer

Emergency thrombectomy in acute upper limb ischemia patient with diabetes mellitus

  • Yunita Arif ,
  • Hermina Novida ,


Background: Acute limb ischemia is a sudden decrease in limb blood perfusion with an onset of less than 14 days, most commonly occurs in lower extremities. Diabetes mellitus, one of diseases underlying peripheral artery disease, complicates the pathophysiology of acute limb ischemia. In this case report we present a patient with type 2 diabetes mellitus and acute limb ischemia in the left upper extremity that had successful thrombectomy treatment.

Case presentation: A 58-year-old female patient came to the Emergency Care Unit of Dr. Soetomo General Hospital with the continuous pain in the five fingers to the palm of the left hand for the past two days. The numbness spread from the elbow to the left fingers, making them weak and difficult to grip. Those five fingers were pale and cold as well. The left hand had no pulsated radialis and ulnar artery, weak brachial pulse and undetected pulse oximetry result. The patient was diagnosed with type 2 diabetes mellitus since 2005 and has a controlled treatment. On the first day of hospitalization, the patient was scheduled for emergency thrombectomy at Dr. Soetomo General Hospital. Follow-up on the seventh-day post-surgery, the patient had no complaints of pain and pale in the left hand and the brachial, ulnar and radial arteries were palpable.

Conclusion: Acute limb ischemia is uncommon in the upper extremities but we found that it has an excellent prognosis with early revascularization, even in a patient with diabetes mellitus. The treatment must be in conjunction with aggressive diabetes mellitus treatment to avoid acute limb ischemia worsening


  1. Gunawansa N. Atraumatic Acute Limb Ischemia: Clinical Presentation, Classification, Assessment and Management- A Review. Int J Vasc Surg Med [Internet]. 2017;3(3):46–52. Available from:
  2. Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med [Internet]. 2019 Aug 14;8(8):1215. Available from:
  3. Mulia E, Dewi I, Julario R, Budiarto M. Percutaneous Aspiration Thrombectomy in Acute Upper Limb Ischemia: A Case Report. Iranian Heart Journal. 2021;22(1):117-24.
  4. Givani CL, Novida H. Critical Limb Ischemia In a Diabetes Mellitus Patient with Atrial Fibrilation. Curr Intern Med Res Pract Surabaya J [Internet]. 2020;1(2):25. Available from:
  5. Budiarto R. Muhammad MD, Hasan MRD. Aorto Femoral Bypass Graft in Chronic Limb Ischemia Patient. Cardiovasc Cardiometabolic J [Internet]. 2021;2(1):41. Available from:
  6. Yang S ling, Zhu L yun, Han R, Sun L lei, Li J xia, Dou J tao. Pathophysiology of peripheral arterial disease in diabetes mellitus. J Diabetes [Internet]. 2016;9(2):133–40. Available from:
  7. Zahra Z, Ramadhani CT, Mamfaluti T, Pamungkas SR, Firdausa S. Association between depression and HbA1c levels in the elderly population with type 2 diabetes mellitus during COVID-19 pandemic. Narra J [Internet]. 2022;2(1). Available from:
  8. Mahmudiono T, Setyaningtyas SW, Rachmah Q, Nindya TS, Megatsari H, Indriani D, et al. Self-efficacy in physical activity and glycemic control among older adults with diabetes in Jagir Subdistrict, Surabaya, Indonesia. Heliyon [Internet]. 2021 Jul 15;7(7):e07578–e07578. Available from:
  9. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes [Internet]. 2015 Jul 10;6(7):961–9. Available from:
  10. Obara H, Matsubara K, Kitagawa Y. Acute Limb Ischemia. Ann Vasc Dis [Internet]. 2018 Dec 25;11(4):443–8. Available from:
  11. Baker S, Diercks D. Acute Limb Arterial Ischemia. Emerg Med [Internet]. 2018;50(3):65–71. Available from:
  12. Bae M, Chung SW, Lee CW, Choi J, Song S, Kim SP. Upper Limb Ischemia: Clinical Experiences of Acute and Chronic Upper Limb Ischemia in a Single Center. Korean J Thorac Cardiovasc Surg [Internet]. 2015/08/05. 2015 Aug;48(4):246–51. Available from:
  13. Fowkes FGR, Aboyans V, Fowkes FJI, McDermott MM, Sampson UKA, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol [Internet]. 2016;14(3):156–70. Available from:
  14. Rhee SY, Kim YS. Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus. Diabetes Metab J [Internet]. 2015 Aug;39(4):283–90. Available from:
  15. Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol [Internet]. 2014 Dec;31(4):378–88. Available from:
  16. Gulati A, Garcia L, Acharji S. Epidemiology of Chronic Critical Limb Ischemia [Internet]. Critical Limb Ischemia. Springer International Publishing; 2016. p. 9–14. Available from:
  17. Nativel M, Potier L, Alexandre L, Baillet-Blanco L, Ducasse E, Velho G, et al. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol [Internet]. 2018 Oct 23;17(1):138. Available from:
  18. Marso SP, Hiatt WR. Peripheral Arterial Disease in Patients With Diabetes. J Am Coll Cardiol [Internet]. 2006;47(5):921–9. Available from:
  19. Jackson MR, Clagett GP. Antithrombotic Therapy in Peripheral Arterial Occlusive Disease. Chest [Internet]. 2001;119(1):283S-299S. Available from:
  20. Shrikhande GV, McKinsey JF. Diabetes and Peripheral Vascular Disease: Diagnosis and Management: Springer Science & Business Media; 2012.
  21. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. J Am Coll Cardiol [Internet]. 2017;69(11):e71–126. Available from:
  22. American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S17-S38. doi: 10.2337/dc22-S002.

How to Cite

Arif, Y., & Novida, H. . (2022). Emergency thrombectomy in acute upper limb ischemia patient with diabetes mellitus. Bali Medical Journal, 11(3), 1811–1816.




Search Panel