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Thrombo-embolic occlusion of the arterial circulation of upper limb, if not optimally treated by surgical or endovascular approach, can cause ischaemic damage of muscles, potentially leading to gangrene and subsequent loss of affected limb. 68 yrs old female, reported to a local hospital with severe pain and pallor of the right arm. Clinical examination and Duplex revealed total loss of arterial circulation from axilla to palm. ECG showed previously unknown Atrial Fibrillation.