Raynaud’s syndrome and upper extremity small artery occlusive disease

All vascular disease specialists encounter occasional patients with xed or intermittent upper extremity ischemia, a group estimated to comprise about 5% of patients with limb ischemia. A large majority of patients with upper extremity ischemia complaints have only intermittent vasospasm of the hands and ngers, a condition termed Raynaud’s syndrome (RS). An estimated 5%–10% of patients with upper extremity ischemia symptoms have severe hand and nger ischemia or digital ischemia ulceration associated with xed arterial occlusive disease of the palmar and digital arteries. Only a small percentage of these patients develop distal arterial occlusion as a result of potentially correctable arterial obstruction at or proximal to the wrist, including proximal subclavian and innominate atherosclerosis, subclavian aneurysms with or without a coexistent cervical rib, subclavian and upper extremity giant cell arteritis, radiation arteritis and associated disorders. e discussion that follows will focus on both upper extremity vasospasm and xed arterial.