Acute non-traumatic upper limb ischemia is mainly due to acute embolic or thrombotic ischemia, differentiation between both is very important as management is different as regard embolectomy, anticoagulation, thrombolytic therapy, bypass surgery or endovascular interventions, different method of diagnosis is available clinically (history and examination), duplex or angiography. The aim of this study is to identify the best method of diagnosis and management.