Upper-extremity ischemia is much less common than lower-extremity ischemia. There are diverse etiologies for upper-extremity ischemia, making the diagnosis challenging. A thorough history and physical examination coupled with noninvasive vascular laboratory studies are important in the diagnosis and treatment of these patients. Noninvasive examinations include duplex ultrasound, segmental arm pressures, digital pressures, arterial waveforms using photoplethysmography, and cold challenge testing. These are the tools that can help evaluate arterial stenosis, occlusion, aneurysm, hemodialysis access, Raynaud's syndrome, and arterial thoracic outlet syndrome.
Get full access to this article
View all access options for this article.
References
1.
YurdakulM., TolaM., UsluO.S.Color Doppler ultrasonography in occlusive diseases of the brachiocephalic and proximal subclavian arteries. J Ultrasound Med2008; 27: 1065–1070.
2.
JagerK.A., PhillipsD.J., MartinR.L.Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol1985; 11: 515–521.
3.
TolaM., YurdakulM., OktenS.Diagnosis of arterial occlusive disease of the upper extremities: Comparison of color duplex sonography and angiography. J Clin Ultrasound2003; 31: 407–411.
4.
TanejaK., JainR., SawhneyS.Occlusive arterial disease of the upper extremity: Colour Doppler as a screening technique and for assessment of distal circulation. Australas Radiol1996; 40: 226–229.
5.
BowerT.C., PairoleroP.C., HallettJ.W.Jr.Brachiocephalic aneurysm: The case for early recognition and repair. Ann Vasc Surg1991; 5: 125–132.
LongleyD.G., YedlickaJ.W., MolinaE.J.Thoracic outlet syndrome: Evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roentgenol1992; 158: 623–630.
8.
SilvaM.B.Jr., HobsonRWII, PappasP.J.A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. J Vasc Surg1998; 27: 302–307.
9.
FerringM., HendersonJ., WilminkA.Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis: Review of the evidence. Nephrol Dial Transplant2008; 23: 1809–1815.
10.
WongV., WardR., TaylorJ.Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg1996; 12: 207–213.
11.
GroganJ., CastillaM., LozanskiL.Frequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: Should duplex ultrasound surveillance be the standard of care?J Vasc Surg2005; 41: 1000–1006.
12.
McLaffertyR.B., EdwardsJ.M., TaylorL.M.Jr.Diagnosis and long-term clinical outcome in patients presenting with hand ischemia. J Vasc Surg1995; 22: 361–367.
13.
NielsenS.L., LassenN.A.Measurement of digital blood pressure after local cooling. J Appl Physiol1977; 43: 907–910.
14.
AllenE., BrownG.Raynaud's disease: A critical review of minimal requisites for diagnosis. Am J Med Sci1932; 83: 187–200.
15.
HirschlM., HirschlK., LenzM.Transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease: Results of ten years of prospective surveillance. Arthritis Rheum2006; 54: 1974–1981.
