Summary
Chronic ischemia of the upper extremity reflects progression of occlusive disease, vasos-pastic disease, or both—vaso-occlusive disease. In contrast to the lower extremity, vasospastic disease is more common and critical in the upper extremity. Although less common in the upper extremity, atherosclerotic disease is functionally more problematic.
When nutritional flow is inadequate for local metabolic demands, chronic ischemia becomes problematic with pain, tissue loss, and persistent infection.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- DBI:
-
Digital brachial index
- PTA:
-
Percutaneous angioplasty
- PVR:
-
Pulse volume recordings
References
Balogh B, Mayer W, Vesely M, Mayer S, Partsch H, Piza-Katzer H. Adventitial stripping of the radial and ulnar arteries in Raynaud's disease. J Hand Surg [Am]. 2002 Nov;27(6):1073–1080.
Chloros GD, Smerlis NN, Li Z, Smith TL, Smith BP, Koman LA. Noninvasive evaluation of upper-extremity vascular perfusion. J Hand Surg [Am]. 2008 Apr;33(4):591–600. PMID: 18406965 [PubMed—in process]
Dalman RL. Upper extremity arterial bypass distal to the wrist. Ann Vasc Surg. 1997 Sep;11(5):550–557. Review.
Dineen S, Smith S, Arko FR. Successful percutaneous angioplasty and stenting of the radial artery in a patient with chronic upper extremity ischemia and digital gangrene. J Endovasc Ther. 2007 June;14(3):426–428.
Drake DB, Kesler RW, Morgan RF. Digital sympathectomy for refractory Raynaud's phenomenon in an adolescent. J Rheumatol. 1992 Aug;19(8):1286–1288.
El-Gammal TA, Blair WF. Digital periarterial sympathec-tomy for ischaemic digital pain and ulcers. J Hand Surg [Br]. 1991 Nov;16(4):382–385.
Ferraresi R, Ferlini M, Sozzi F, Pomidossi G, Caravaggi C, Danzi GB. Images in cardiovascular medicine. Percutaneous transluminal angioplasty for treatment of critical hand ischemia. Circulation. 2006 Aug 8;114(6):e232–234.
Gray H. Gray's Anatomy of the Human Body. 29th American edn. In: Goss CM, ed. Philadelphia, PA: Lea & Febiger; 1973:613, 615, 618, 621, 623..
Guzman-Stein G, Schubert W, Najarian DW, Press BH, Cunningham BL. Composite in situ vein bypass for upper extremity revascularization. Plast Reconstr Surg. 1989 Mar;83(3):533–536.
Hashimoto H. Impaired microvascular vasodilator reserve in chronic cigarette smokers–a study of post-occlusive reactive hyperemia in the human finger. Jpn Circ J. 1994 Jan;58(1):29–33.
Heller F, Wei W, Wei FC. Chronic arterial insufficiency of the hand with fingertip necrosis 1 year after harvesting a radial forearm free flap. Plast Reconstr Surg. Sep 1;2004 114(3):728–731.
Hsieh CH, Tsai HH, Yin JW, Lin TS, Jeng SF. Salvage of the hand with a free flap in a hemodialysis patient with fin-ger gangrene and ipsilateral arteriovenous fistula: a case report. Ann Vasc Surg. 2004 May;18(3):365–368.
Hughes K, Hamdan A, Schermerhorn M, Giordano A, Scovell S, Pomposelli F Jr. Bypass for chronic ischemia of the upper extremity: results in 20 patients. J Vasc Surg. 2007 Aug;46(2):303–307.
Hussey HH. Digital gangrene. JAMA. 1976 Dec. 6;236 (23):2656.
Jones NF. Acute and chronic ischemia of the hand: pathophysiology, treatment, and prognosis. J Hand Surg [Am]. 1991 Nov;16(6):1074–1083.
Jones NF. Ischemia of the hand in systemic disease. The potential role of microsurgical revascularization and digital sympathectomy. Clin Plast Surg. 1989 July;16(3): 547–556. Review.
Katz SG, Kohl RD. Direct revascularization for the treatment of forearm and hand ischemia. Am J Surg. 1993 Mar;165(3):312–316. Review.
Koman LA, Ruch DS, Aldridge M, Smith BP, Holden MB, Fulcher M. Arterial reconstruction in the ischemic hand and wrist: effects on microvascular physiology and health-related quality of life. J Hand Surg [Am]. 1998 Sep;23(5):773–782.
Koman LA, Smith B P, Pollock FE Jr, SmithTL, Pollock D, Russell GB. The microcirculatory effects of peripheral sympathectomy. J Hand Surg [Am].. Sep;1995 20(5): 709–717.
Kotsis S V, Chung KC. A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia. J Rheumatol. 2003 Aug;30(8):1788–1792. Review.
Kransdorf MJ, Turner-Stepahin S, Merritt WH. Magnetic resonance angiography of the hand and wrist: evaluation of patients with severe ischemic disease. J Reconstr Microsurg. 1998 Feb;14(2):77–81.
Kryger ZB, Rawlani V, Dumanian GA. Treatment of chronic digital ischemia with direct microsurgical revasculariza-tion. J Hand Surg [Am]. 2007 Nov;32(9):1466–1470.
Laroche G P, Bernatz PE, Joyce JW, MacCarty CS. Chronic arterial insufficiency of the upper extremity. Mayo Clin Proc. 1976 Mar;51(3):180–186.
McCall TE, Petersen DP, Wong LB. The use of digital artery sympathectomy as a salvage procedure for severe ischemia of Raynaud's disease and phenomenon. J Hand Surg [Am]. 1999 Jan;24(1):173–177.
McNamara MF, Takaki HS, Ya o JS, Bergan JJ. A systematic approach to severe hand ischemia. Surgery. 1978 Jan;83(1):1–11. Review.
Mills JL, Fujitani RM. Acute and chronic upper extremity ischemia. II. Small vessel arterial occlusive disease. Ann Vasc Surg. 1993 Mar;7(2):195–199.
Namdari S, Park MJ, Weiss AP, Carney WI. Chronic hand ischemia treated with radial artery balloon angioplasty: case report. J Hand Surg [Am]. 2008 Apr;33(4):551–554. PMID: 18406959 [PubMed—in process]
Namdari S, Weiss AP, Carney WI Jr. Palmar bypass for digital ischemia. J Hand Surg [Am]. 2007 Oct;32(8):1251–1258. PMID: 17923311 (PubMed—indexed for MEDLINE.)
Nehler MR, Dalman RL, Harris EJ, Taylor LM Jr, Porter JM. Upper extremity arterial bypass distal to the wrist. J Vasc Surg. 1992 Oct;16(4):633–640; discussion 640–642.
O'Brien BM, Kumar PA, Mellow CG, Oliver T V. Radical microarteriolysis in the treatment of vasospastic disorders of the hand, especially scleroderma. J Hand Surg [Br]. 1992 Aug;17(4):447–452.
Ortensi A, Salsano F, Trinchi S, D'orazi V, Pisarri S. Microsurgical distal sympathectomy in chronic vasos-pastic syndromes of the hand. Int Surg. Apr—June. 2005; 90(2):88–92.
Ouriel K. Noninvasive diagnosis of upper extremity vascular disease. Semin Vasc Surg. 1998 June;11(2):54–59. Review.
Pederson WC. Revascularization of the chronically isch-emic hand. Hand Clin. 1999 Nov;15(4):629–642. Review.
Ristow AV, Cury JM, Costa EL, GardeazĂ¡bal G, Sampaio MM, Peixoto CC. Revascularization of the ischaemic hand using in situ veins. Cardiovasc Surg. 1996 Aug;4(4):466–469.
Ruch DS, Holden M, Smith BP, Smith TL, Koman LA. Periarterial sympathectomy in scleroderma patients: intermediate-term follow-up. J Hand Surg [Am]. 2002 Mar;27(2):258–264. PMID: 11901385 (PubMed—indexed for MEDLINE.)
Summers AN, Matloub HS, Sanger JR. Salvage of isch-emic digits using a lateral arm fascial flap. Plast Reconstr Surg. 2001 Feb;107(2):398–407.
Taylor LM Jr, BaurGM, Porter JM. Finger gangrene caused by small artery occlusive disease. Ann Surg. Apr;1981; 193(4):453–461.
Tham S, Grossman JA. Limited microsurgical arteriolysis for complications of digital vasospasm. J Hand Surg [Br]. 1997 June;22(3):359–361.
Walgenbach KJ, Voigt M, Andree C, Stark GB, Horch RE. Management of hypovascularized wounds not responding to conventional therapy by means of free muscle transplantation. VASA. 2001 July; 30(3):206–211.
Wilgis EF. Digital sympathectomy for vascular insuffi-ciency. Hand Clin. 1985 May;1(2):361–367.
Wilgis E F. Evaluation and treatment of chronic digital ischemia. Ann Surg. 1981 June;193(6):693–698.
Yee AM, Hotchkiss RN, Paget SA. Adventitial stripping: a digit saving procedure in refractory Raynaud's phenomenon. J Rheumatol. 1998 Feb;25(2):269–276.
Zhang WW, Harris LM, Shenoy SS, Hassett JM, Wall L P. Outcomes of patients with atherosclerotic upper extremity tissue loss. Vasc Endovascular Surg. 2005 Jan–Feb; 39(1):33–38.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag London Limited
About this chapter
Cite this chapter
Hendrickson, M.F. (2010). Chronic Arterial Ischemia of the Upper Extremity: Diagnosis, Evaluation, and Surgical Management. In: Siemionow, M.Z., Eisenmann-Klein, M. (eds) Plastic and Reconstructive Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-513-0_40
Download citation
DOI: https://doi.org/10.1007/978-1-84882-513-0_40
Publisher Name: Springer, London
Print ISBN: 978-1-84882-512-3
Online ISBN: 978-1-84882-513-0
eBook Packages: MedicineMedicine (R0)