Related Experiment Videos
Chronic vascular disease of the upper extremity: radiologic and clinical features
Insights
Chronic vascular diseases of the upper extremity include subclavian artery occlusions, thoracic outlet syndrome, and angiospastic hand disease. Diagnosis begins with arch aortography and selective catheterization for accurate assessment.
Area of Science:
- Vascular Surgery
- Radiology
- Vascular Medicine
Background:
- Chronic vascular diseases affecting the upper extremity are significant clinical concerns.
- Key conditions include subclavian artery occlusions, thoracic outlet syndrome, and angiospastic disease of the hand.
- These conditions can lead to serious ischemic symptoms and complications.
Purpose of the Study:
- To outline the major chronic vascular diseases of the upper extremity.
- To describe the presentation and diagnostic approach for these conditions.
- To emphasize the importance of appropriate imaging for diagnosis.
Main Methods:
- The study reviews common chronic vascular diseases of the upper extremity.
- Diagnostic evaluation involves arch aortography as the initial step.
- Selective catheterization is employed for presumed involved vessels.
Main Results:
- Subclavian artery lesions can cause subclavian steal syndrome or peripheral embolization leading to hand ischemia.
- Thoracic outlet syndrome may involve stenosis of the subclavian artery, vein, or brachial plexus, with embolization as a possibility.
- Angiospastic disease presents in three forms: Raynaud's disease, asphyxia manus et digitorum, and digitus moriens/mortuus.
Conclusions:
- Accurate diagnosis of upper extremity vascular disease requires a systematic imaging approach.
- Arch aortography followed by selective catheterization is crucial for identifying the extent and nature of vascular compromise.
- Understanding these distinct vascular pathologies is essential for effective patient management.
Abstract:
The major chronic vascular diseases of the upper extremity are (1) subclavian artery occlusions, (2) thoracic outlet syndrome, and (3) angiospastic disease of the hand. Central subclavian artery lesions ease of the hand. Central subclavian artery lesions can have either hemodynamic consequences (subclavian steal syndrome) or, by peripheral embolization, can provoke ischemic symptoms of the hand. Costoclavicular narrowing can cause functional or fixed stenosis of the subclavian artery and can also involve the vein or brachial plexus. Symptoms due to pressure on the brachial plexus are most frequent, but embolization to the peripheral vessels may also occur. Angiospastic disease, the most frequent lesion of upper extremity vessels, comprises three types: Raynaud's disease, in which there are intermittent attacks of coldness and discoloration without evidence of occlusion on the angiogram; asphyxia manus et digitorum in which the attacks are also intermittent but there is morphologic evidence of occlusion; and digitus moriens or mortuus, in which there is a painful, permanent discoloration. All investigations of chronic vascular disease of the upper extremity should begin with arch aortography and then proceed to a selective catheterization of the vessels that are presumed to be involved.