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Anatomic and physiologic evaluation of upper extremity ischemia
D S Ruch1, T L Smith, B P Smith
1Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
Microsurgery
|May 21, 1999
Summary
Arteriography and laser Doppler perfusion imaging (LDPI) offer complementary insights into upper extremity ischemia. While arteriography is a poor indicator of nutritional flow, LDPI and symptoms correlate with functional status and cold sensitivity.
Area of Science:
- Vascular Medicine
- Medical Imaging
- Diagnostic Techniques
Background:
- Digital ischemia can significantly impact hand function and quality of life.
- Accurate assessment of blood flow is crucial for diagnosing and managing upper extremity ischemia.
- Arteriography and laser Doppler perfusion imaging (LDPI) are commonly used diagnostic tools.
Purpose of the Study:
- To evaluate the accuracy of arteriography and LDPI in predicting digital ischemia.
- To correlate upper extremity symptoms, function, and nutritional flow with these imaging techniques.
- To determine the utility of each method in assessing cold intolerance.
Main Methods:
- Arteriography was performed to identify occlusive disease in 25 hands (23 patients).
- Laser Doppler perfusion imaging (LDPI) was used to assess digital perfusion.
- Patient questionnaires collected data on symptoms, pain, cold sensitivity, and function.
Main Results:
- Arteriography showed multiple-level occlusive disease in 25 hands, while LDPI identified hypoperfusion in 17 hands.
- Arteriography was a poor predictor of nutritional perfusion as measured by LDPI.
- Neither imaging technique predicted the severity of cold intolerance.
- Upper extremity symptoms and function correlated with LDPI measurements and cold sensitivity.
Conclusions:
- Laser Doppler perfusion imaging and arteriography provide complementary data for evaluating upper extremity ischemia.
- LDPI may offer a more direct assessment of nutritional flow compared to arteriography.
- Patient-reported symptoms and functional status are important considerations alongside imaging findings.