Editing Arm artery occlusion


Symptomatic arterial occlusive disease is seen much more in leg than arm.

* However, functional impairment can be much more severe in arm

The key to this is picking up on aetiology and treating specifically for that cause.

== Aetiology ==

* Vasospasm
* Intrinsic arterial disease
** Atherosclerosis (most common)
** Usually limited to more proximal arteries
** ESRF - azotaemic arteriopathy
* Inflammatory
** Initial inflammatory phase - fever, arthritis, myalgias, ESR
* Embolism
** Macroemboli are mostly cardiac in origin
** Typically lodge brachial artery just proximal to deep brachial artery takeoff
** Forearm/hand ischaemia
** Microemboli) lodge more distally) are more likely to have an arterial origin - aneurysm/ulcerative lesion within distal subclavian, a/w thoracic outlet syndrome. Unilateral Raynaud's disease is a common presentation of thoracic outlet syndrome.
* Trauma
** Esp repetitive trauma e.g. manual labour

== Evaluation ==

* Symptoms - colour changes, coolness, numbness, weakness, effort-induced fatigue (large vessel occlusive disease), ischaemic rest pain, tissue loss etc. Raynaud's phenomenon (pallor -> cyanosis -> hyperaemic rubor)
* Laterality - if bilateral, implies systemic cause. E.g. inflammatory
* Risk factors for atherosclerotic disease
* BP in both arms
* Pulses in neck, arms, lower limbs

== Labs ==

* Hypercoagulable state - factor v leiden, antithrombin III deficiency, protein C/S, antiphospholipid antibodies, prothrombin gene mutation, hyperhomocysteinaemia
* Connective tissue disorders - RF, ANA, complement, ESR
* ECG/TTE
* Plain films of neck

== Management ==

* Vasospasm - abstain from tobacco, avoid cold, try vasodilators
* Atherosclerotic risk factor management
* Revascularisation for chronic vessel disease is limited to limb salvage situations for patients with critical ischaemia (tissue loss or rest pain) or debilitating symptoms of effort fatigue
* Acute arterial occlusions should be addressed when diagnosed
* Trauma
** Should be fixed at time of diagnosis
** Sometimes end-to-end anastamosis can be done. More often need saphenous graft interposition.

== Endovascular therapy ==

* Used to treat short occlusive segments in proximal vessels, esp left subclavian
* Can be antegrade (femoral) or retrograde (brachial) approach

== Open revascularisation ==

* Proximal subclavian occlusion
** Carotid subclavian bypass/subclavian transposition
* Axillary artery
** Occlusive lesions are unusual
** Commonly trauma or neglected emboli
* Brachial artery
** Lesions are rare - commonly emboli or trauma
* Radial and ulnar arteries
** Bypass rarely necessary
** Again, trauma and emboli

[[Category:Vascular]]