Upper extremity ischemia

Diagnosis and treatment of upper extremity ischemia within the prevue of vascular surgery. It is, however, a relatively infrequently encountered problem in most vascular practices. The following exchange highlights the principles of evaluation of patients with upper extremity ischemia. In general, such patients should be evaluated for two specific questions: Is the upper extremity ischemia produced by large or small artery diseased And, if it is produced by small artery disease, is it occlusive disease or vasospastic disease? Large artery disease generally produces symptoms as a result of embolization. Large artery disease can be localized by a combination of physical examination and segmental pressures. It usually occurs in vessels proximal to the wrist and requires evaluation by angiography and eventually intervention of some type to eliminate the embolic source. Symptoms are generally unilateral. Small artery disease, by definition, occurs in vessels distal to the wrist, generally produces bilateral symptoms, and has normal vascular laboratory findings proximal to the wrist. Occlusive disease is suspected by diminished digital artery pressures, and vasospastic disease can be suspected by a positive response to a digital hypothermic challenge test. In the following exchange, a patient with complex upper extremity ischemia is evaluated systematically by working through these considerations.