Upper Limb Ischemia

Introduction

Plaque buildup in the arteries(called atherosclerosis) that carry blood to your head, organs, and limbs

Plaque is made up of fat, cholesterol, calcium, fibrous tissue can harden and narrow the arteries

Limits the flow of oxygen-rich blood from your heart to your hands, legs, head, kidneys and stomach

Here we will here focus on P.A.D. that affects blood flow to the hands.

Less common than Lower Limb Disease due to the arms’ closer proximity to the heart, and the fact that most patients are asymptomatic

Causes

Smoking
Diabetes
High amounts of certain fats and cholesterol in the blood
Tobacco usage in any form
High blood pressure
Inherent blood clotting issues
Old age
Obesity
Thoracic Outlet syndrome
Raynauds syndrome
Idiopathic(unknown)

Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site

Types

Acute- Sudden block of the blood vessels causing immediate threat to the hand

High risk of amputation

Needs urgent treatment

Chronic- Gradual decrease in blood flow

Needs treatment of underlying cause

Associated health issues

P.A.D. increases your risk of coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”)

Clinical Features

Weak or absent pulses in the hands
Intermittent Claudication- symptoms when using the arms and forearms for work which may include pain, numbness, aching, or heaviness in the muscles. Symptoms also may include cramping in the affected side
Pain in the finger tips even at rest
Sores or wounds on the fingers that heal slowly, poorly, or not at all
Gangrene (tissue death)- black color change of skin and tissue
Infected wounds
A pale or bluish color to the skin
A lower temperature in one hand compared to the other hand

Diagnostic Tests

Doppler Ultrasound
Stress position tests
X-rays of neck to see bony abnormalities
Computerised Tomographic Angiogram (CT Scan)
Magnetic Resonance Angiogram (MRI Scan)
Angiogram

Treatment

Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.

Overall goals- improving symptoms and quality of life, ; reducing symptoms of claudication, reduce infection, heal wounds, reducing risk of heart attack, kidney failure and stroke

Target of treatment in Claudicants- improve painfree period

Target of treatment in individuals with wounds/gangrene- remove dead tissue, heal the wound and preserve healthy tissue

Healthy Lifestyle Changes

Physical activity
Quitting smoking
Heart-healthy eating

Treatment options

Bypass Grafting/Embolectomy Surgery- open surgery