Vascular Insufficiency/Chronic Ischemia in the Upper Extremity-Vascular Insufficiency of the Upper Extremity

Vascular Insufficiency of the Upper Extremity

Pdf Summary

Vascular insufficiency of the upper extremity can result from acute vascular injury, chronic vasospastic disease, and occlusive disease. Treatment involves understanding the vascular anatomy of the upper extremity, using diagnostic modalities, and considering medical and surgical management options. The brachial artery serves as the dominant blood supply to the distal extremities, and occlusion above its bifurcation can lead to ischemia. Collateral flow is provided by the deep brachial artery, the superior ulnar collateral artery, and the inferior ulnar collateral artery. The radial artery is more superficial than the ulnar artery in the proximal forearm, while the ulnar artery is deeper. Variations in the path or source of these arteries are possible, with the radial artery often larger at wrist level. The blood vessels of the hand communicate through two palmar arches and one dorsal arch. Collateral flow across the elbow is essential for continued perfusion of the limb. Acute vascular injury typically requires repair, while chronic vascular insufficiency may benefit from vascular reconstruction. Ultrasound-guided thrombin injection has been successful in treating ulnar and radial artery pseudoaneurysms. Botulinum toxin A has also shown promise in the treatment of vasospastic diseases, providing pain relief and improving digit perfusion in some patients. Further research is needed to determine the optimal dose and dosing frequency for botulinum toxin A treatment.

Keywords

Vascular insufficiency

Upper extremity

Acute vascular injury

Chronic vasospastic disease

Occlusive disease

Vascular anatomy

Diagnostic modalities

Medical management

Surgical management

Ischemia