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Chronic upper extremity ischemia: current concepts in management.

S J Williams

    The Surgical Clinics of North America
    |April 1, 1986
    PubMed
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    Symptomatic innominate or subclavian artery obstructions often cause neurologic and extremity issues. Surgical repair or balloon angioplasty can reverse these symptoms, with sympathectomy offering a solution when perfusion restoration is incomplete.

    Area of Science:

    • Vascular Surgery
    • Neurology
    • Interventional Cardiology

    Background:

    • Innominate and subclavian artery obstructions can lead to significant neurologic and extremity symptoms.
    • These conditions are often associated with concomitant carotid disease, increasing stroke risk.

    Purpose of the Study:

    • To review the management of symptomatic innominate or subclavian artery obstructions.
    • To highlight the effectiveness of various surgical and interventional approaches.

    Main Methods:

    • Review of extrathoracic surgical approaches for innominate/subclavian obstructions.
    • Evaluation of balloon angioplasty utility.
    • Assessment of carotid disease management's impact on subclavian steal symptoms.
    • Analysis of reconstruction outcomes for lesions distal to the vertebral artery.

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  • Consideration of sympathectomy's role.

    • Main Results:

    • Extrathoracic surgical approaches effectively reverse neurologic and extremity symptoms.
    • Balloon angioplasty shows emerging utility for these obstructions.
    • Correction of concomitant carotid disease can prevent stroke and mitigate subclavian steal symptoms.
    • Reconstruction of lesions distal to the vertebral artery yields dramatic and durable improvement.
    • Sympathectomy is valuable when complete perfusion restoration is not achievable.

    Conclusions:

    • Symptomatic innominate and subclavian artery obstructions are treatable with various methods.
    • Surgical and interventional strategies offer effective symptom reversal and stroke prevention.
    • Sympathectomy provides a therapeutic option for complex cases.