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Discriminant arteriographic criteria in the management of forearm and hand ischemia
Insights
Arteriography effectively diagnosed forearm and hand ischemia caused by occlusive lesions or vasospasm. Detailed arteriographic findings guided therapeutic interventions for upper extremity vascular disease.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Interventional Radiology
Background:
- Forearm and hand ischemia can result from various vascular pathologies.
- Accurate diagnosis is crucial for effective treatment of upper extremity ischemia.
- Arteriography plays a key role in evaluating complex vascular conditions.
Purpose of the Study:
- To evaluate the utility of aortic arch and selective upper extremity arteriography.
- To assess the diagnosis of forearm and hand ischemia.
- To correlate arteriographic findings with therapeutic interventions.
Main Methods:
- Retrospective review of 55 patients undergoing aortic arch and upper extremity arteriography (1971-1980).
- Analysis of arteriographic findings including lesion morphology, distribution, and collateral circulation.
- Utilized vasodilatory pharmacoangiography with magnification for detailed vessel assessment.
Main Results:
- Fifty-one patients (93%) had organic occlusive lesions affecting subclavian, axillobrachial, radial-ulnar, or palmar-digital arteries.
- Nine patients presented with distal emboli secondary to proximal occlusive disease.
- Four patients (7%) exhibited vasospastic disease; vasodilatory pharmacoangiography aided diagnosis.
Conclusions:
- Arteriography is essential for diagnosing the causes of forearm and hand ischemia.
- Detailed arteriographic assessment, including collateral patterns, is critical for treatment planning.
- Comprehensive arteriographic studies prevent misleading evaluations and guide appropriate therapeutic interventions.
Abstract:
Fifty-five patients (33 male and 22 female), 3 to 73 years in age, underwent aortic arch and selective upper extremity arteriography for the evaluation of forearm and hand ischemia from 1971 to 1980. Fifty-one patients had organic occlusive lesions (12 subclavian, 15 axillobrachial, 17 radial-ulnar, and 7 palmar-digital), including distal forearm and hand emboli, as a consequence of proximal occlusive disease in nine patients (5 subclavian, 2 axillobrachial, and 2 radial-ulnar). The remaining four patients had vasospastic disease. Major arteriographic findings of obstructive disease were defined by: morphology of lesions, symmetry or asymmetry of obstructions, segmental versus tandem lesion distribution, and the resultant pattern of collateral circulation. Vasodilatory pharmacoangiography with magnification technique frequently facilitated evaluation of digital and collateral vessels. Therapeutic interventions were dictated by clinical data heavily weighed by the arteriographic examination. Limited arteriographic studies would have been misleading in the evaluation of many patients.