Management of severe ischemia of the upper extremity

Ischemia of the upper extremity is unusual, particularly in patients without trauma or iatrogenic injury to the vessels of the arm. Some authors have suggested that ischemia of the upper extremity is one sixth as common as that in the leg. Management of patients with vascular trauma or iatrogenic injury is usually straightforward, with direct repair or vein grafting of the injured vessel. Patients with ischemia from vascular disease, however, present a different set of management problems. These individuals often suffer from systemic medical problems that lead to their vascular disease, which is often very severe and accelerated because of the underlying cause. This article discusses the approach to these patients and options for management.