SUBCLAVIAN, axillary, and brachial artery emboli account for approximately 20% of peripheral arterial emboli.1 Most emboli arise in the heart and in our experience upper-extremity emboli are more commonly associated with prior myocardial infarction than with preexisting rheumatic heart disease. Another more recently recognized cause of axillary and brachial artery emboli is transaxillary aortography. Although this latter complication may be more appropriately termed a thrombosis, the technique for removal is the same as that for the more commonly recognized upper-extremity embolus.
The diagnosis of subclavian, axillary, or brachial artery embolus is quite straightforward. An absent pulse high in the axilla is noted with a subclavian artery embolus, while with axillary or brachial artery emboli it is usually possible to detect a proximal pulse high in the axilla. Preoperative arteriography is neither necessary nor indicated. Heparin sodium (5,000 to 7,500 units) should be administered intravenously when the diagnosis is made