Purpose Assessment of upper limb ischaemia is primarily clinical, with current non-invasive methods of quantifying upper limb perfusion (e.g. oxygen saturation or digital-pressures) being non-standardised. Hand acceleration times (HATS) is a novel non-invasive ultrasound based perfusion measurement that could aid in the diagnosis of upper limb ischaemia, however there has been limited characterisation of it in the literature. This study sought to compare HATS values in a patients with or without sonographic evidence of arterial disease. Methodology This was a single-centre prospective study of patients who were referred to Vascular Surgery with clinical concern for upper limb ischaemia or with a arteriovenous fistula issue, and who underwent HATS measurement. Patients were categorised into those that had a sonographic evidence of arterial disease (PAD; stenosis >50% or occlusion), and those that didn’t. Demographic, comorbidity, and clinical presentation data was collected. Data was analysed using t- and χ2 tests and is expressed as mean±SD or %. Results 28 patients were included, 15 (59±18y, 47% male) with PAD and 13 (57±21y, 62% male) without. There was no difference in comorbidities between groups, except for higher antiplatelet use in the PAD group (60 vs 23%, p=0.049). Across the cohort, rest pain was the most common presentation (57.1%), followed by tissue loss (17.9%), then claudication (10.7%). There was no difference in the proportion of patients presenting with each symptom between groups. HATS was significantly worse (higher) in the PAD group 162ms vs 83ms (p=0.0097). In a subset of five patients with digital tissue loss, HATS values were the same in digits with and without tissue loss (128 vs 132ms). Conclusion HATS measurement appears to correspond appropriately to stenotic or occlusive arterial disease, and may be a sensitive diagnostic tool for upper limb ischaemia. Further work is required to validate HATS against current upper limb perfusion measures.