Impact of Bilateral Upper-Extremity Stenoses in the Diagnosis of Atherosclerotic Disease

Abstract

Clinically significant differences in upper-extremity blood pressures usually are the result of atherosclerotic plaque, resulting in a reduction in blood pressure to one upper extremity. Less commonly, both upper extremities will have hemodynamically significant stenoses. Unrecognized, these bilateral stenoses put patients at an increased risk for cardiovascular events. The described patient presented to the emergency room with transient ischemic symptoms. Because of the low brachial blood pressures, bilaterally she was diagnosed and treated for hypotension as the result of dehydration. The patient's primary care provider subsequently referred the patient to the vascular laboratory where identification of the multiple, bilateral stenoses was made.