Background: Acute upper limb ischemia (AULI) is an uncommon vascular emergency with severe morbid consequences if unsuccessfully treated. Surgical treatment, commonly involving embolectomy, has become the mainstay for embolic or thrombotic AULI treatment. AULI can be managed conservatively as compared to lower limb ischemia due to the collateral circulation. Despite the regular use of conservative management in everyday practice as an alternative to surgery, the absence of reports utilising conservative anticoagulation management in AULI exists in the literature. Methods: It is a single-centre retrospective and prospective study including 59 patients presenting with AULI to the Department of Vascular Surgery, Army Hospital R & R from January 2012 to December 2019. Any patient presenting after more than 30 days of onset of Acute upper limb Ischemia and developing AULI following endovascular access of the Brachial and Radial Artery were excluded. Imaging done was Trans thoracic Echocardiogram (TTE), Trans Oesophageal Echocardiogram (TEE), CDFI (Colour Doppler flow imaging) and Computerised Tomography angiogram (CTA). The primary outcome was the need for a major amputation (above the wrist) and mortality during the hospital stay. Results: 54 patients were male. The mean age was 44.9±13 years. commonest site was the Brachial Artery 53% (26 out of 49) and Axillary Artery 35% (17 out of 49) when Iatrogenic, Traumatic and Thoracic Outlet Syndromes as causes were excluded. Out of 59 patients, 10 patients were managed conservatively, 04 patients underwent amputation, rest were managed with thrombo-embolectomy or bypass Conclusion: CT Angiography, when available, is well accepted first-line investigation for AULI. AULI as compared with lower limb ischemia due to the collateral circulation can be managed conservatively, provided it is not associated with tissue loss.