Skip to main content
PMC home page
Journal of the Royal Society of Medicine logoLink to Journal of the Royal Society of Medicine
. 1992 May;85(5):269–273. doi: 10.1177/014107689208500509

Critical ischaemia of the upper limb.

M S Quraishy 1, S J Cawthorn 1, A E Giddings 1
PMCID: PMC1294603  PMID: 1433088

Abstract

Fifty-seven patients who presented to the Royal Surrey County Hospital, Guildford, with critical upper limb ischaemia between 1980 and 1989 were studied. Only 13 patients had emboli, while 23 presented with arteritis, seven involving large vessels and 16 with small vessel disease. Other causes included nine patients with trauma, six with atherosclerosis (of whom five were women), and four with vascular complications of thoracic outlet obstruction. Single examples of ischaemia due to radiation fibrosis and disseminated intravascular coagulation were also seen. Critical ischaemia of the upper limb remains an uncommon yet challenging problem. The review demonstrates that total limb arteriography should be performed in all patients, except the minority who present with direct arterial trauma or classical emboli.

Full text

PDF
269

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BAIRD R. J., LAJOS T. Z. EMBOLI TO THE ARM. Ann Surg. 1964 Nov;160:905–909. doi: 10.1097/00000658-196411000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blacklay P. F., Duggan E., Wood R. F. Vascular trauma. Br J Surg. 1987 Dec;74(12):1077–1083. doi: 10.1002/bjs.1800741204. [DOI] [PubMed] [Google Scholar]
  3. Butler M. J., Lane R. H., Webster J. H. Irradiation injury to large arteries. Br J Surg. 1980 May;67(5):341–343. doi: 10.1002/bjs.1800670513. [DOI] [PubMed] [Google Scholar]
  4. COHEN A., MANION W. C., SPENCER F. C., CZARNECKI S. W., DEBAKEY M. E. Occlusive lesions of the great vessels of the aortic arch. Surgical and pathological aspects. Arch Surg. 1962 Jun;84:628–642. doi: 10.1001/archsurg.1962.01300240032006. [DOI] [PubMed] [Google Scholar]
  5. Clifford P. C., Martin M. F., Sheddon E. J., Kirby J. D., Baird R. N., Dieppe P. A. Treatment of vasospastic disease with prostaglandin E1. Br Med J. 1980 Oct 18;281(6247):1031–1034. doi: 10.1136/bmj.281.6247.1031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cossman D. V., Ellison J. E., Wagner W. H., Carroll R. M., Treiman R. L., Foran R. F., Levin P. M., Cohen J. L. Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg. 1989 Nov;10(5):522–529. doi: 10.1067/mva.1989.14963. [DOI] [PubMed] [Google Scholar]
  7. Crawford E. S., De Bakey M. E., Morris G. C., Jr, Howell J. F. Surgical treatment of occlusion of the innominate, common carotid, and subclavian arteries: a 10 year experience. Surgery. 1969 Jan;65(1):17–31. [PubMed] [Google Scholar]
  8. HALL K. V., HILLESTAD L. K. Raynaud's phenomenon treated with sympathectomy. A follow-up study of 28 patients. Angiology. 1960 Jun;11:186–189. doi: 10.1177/000331976001100305. [DOI] [PubMed] [Google Scholar]
  9. Hammacher E. R., Eikelboom B. C., van Lier H. J., Skotnicki S. H., Wijn P. F. Brachial artery lesions after cardiac catheterisation. Eur J Vasc Surg. 1988 Jun;2(3):145–149. doi: 10.1016/s0950-821x(88)80066-5. [DOI] [PubMed] [Google Scholar]
  10. Hight D. W., Tilney N., Couch N. P. Changing clinical trends in patients with peripheral arterial emboli. Surgery. 1976 Feb;79(02):172–176. [PubMed] [Google Scholar]
  11. Isohisa I., Numano F., Maezawa H., Sasazuki T. HLA-Bw52 in Takayasu disease. Tissue Antigens. 1978 Oct;12(4):246–248. doi: 10.1111/j.1399-0039.1978.tb01332.x. [DOI] [PubMed] [Google Scholar]
  12. Jarrett F., Dacumos G. C., Crummy A. B., Detmer D. E., Belzer F. O. Late appearance of arterial emboli: diagnosis and management. Surgery. 1979 Dec;86(6):898–905. [PubMed] [Google Scholar]
  13. Jarrett F., Hirsch S. A. Current diagnosis and management of upper extremity ischemia. Surg Annu. 1983;15:207–228. [PubMed] [Google Scholar]
  14. Jarrett P. E., Morland M., Browse N. L. Treatment of Raynaud's phenomenon by fibrinolytic enhancement. Br Med J. 1978 Aug 19;2(6136):523–525. doi: 10.1136/bmj.2.6136.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Joyce J. W. The giant cell arteritides: diagnosis and the role of surgery. J Vasc Surg. 1986 May;3(5):827–833. doi: 10.1067/mva.1986.avs0030827b. [DOI] [PubMed] [Google Scholar]
  16. Kaar G., Broe P. J., Bouchier-Hayes D. J. Upper limb emboli. A review of 55 patients managed surgically. J Cardiovasc Surg (Torino) 1989 Mar-Apr;30(2):165–168. [PubMed] [Google Scholar]
  17. Karmody A. M., Lempert N., Jarmolych J. The pathology of post-catheterization brachial artery occlusion. J Surg Res. 1976 Jun;20(6):601–606. doi: 10.1016/0022-4804(76)90097-4. [DOI] [PubMed] [Google Scholar]
  18. Keenan J. P., Robbs J. V. The ischaemic hand and upper limb--a diagnostic and therapeutic dilemma. S Afr J Surg. 1985 Mar;23(1):11–14. [PubMed] [Google Scholar]
  19. Klein R. G., Hunder G. G., Stanson A. W., Sheps S. G. Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med. 1975 Dec;83(6):806–812. doi: 10.7326/0003-4819-83-6-806. [DOI] [PubMed] [Google Scholar]
  20. McCarthy W. J., Flinn W. R., Yao J. S., Williams L. R., Bergan J. J. Result of bypass grafting for upper limb ischemia. J Vasc Surg. 1986 May;3(5):741–746. [PubMed] [Google Scholar]
  21. McNamara M. F., Takaki H. S., Yao J. S., Bergan J. J. A systematic approach to severe hand ischemia. Surgery. 1978 Jan;83(1):1–11. [PubMed] [Google Scholar]
  22. Porter J. M., Rivers S. P., Anderson C. J., Baur G. M. Evaluation and management of patients with Raynaud's syndrome. Am J Surg. 1981 Aug;142(2):183–189. doi: 10.1016/0002-9610(81)90272-5. [DOI] [PubMed] [Google Scholar]
  23. Ricotta J. J., Scudder P. A., McAndrew J. A., De Weese J. A., May A. G. Management of acute ischemia of the upper extremity. Am J Surg. 1983 May;145(5):661–666. doi: 10.1016/0002-9610(83)90117-4. [DOI] [PubMed] [Google Scholar]
  24. Rösch J., Porter J. M., Gralino B. J. Cryodynamic hand angiography in the diagnosis and management of Raynaud's syndrome. Circulation. 1977 May;55(5):807–814. doi: 10.1161/01.cir.55.5.807. [DOI] [PubMed] [Google Scholar]
  25. Sano K., Aiba T., Saito I. Angiography in pulseless disease. Radiology. 1970 Jan;94(1):69–74. doi: 10.1148/10.1148/94.1.69. [DOI] [PubMed] [Google Scholar]
  26. Satiani B., Gross W. S., Evans W. E. Improved limb salvage after arterial embolectomy. Ann Surg. 1978 Aug;188(2):153–157. doi: 10.1097/00000658-197808000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schmidt F. E., Hewitt R. L. Severe upper limb ischemia. Arch Surg. 1980 Oct;115(10):1188–1191. doi: 10.1001/archsurg.1980.01380100036008. [DOI] [PubMed] [Google Scholar]
  28. Sise M. J., Counihan C. M., Shackford S. R., Rowley W. R. The clinical spectrum of Takayasu's arteritis. Surgery. 1988 Nov;104(5):905–910. [PubMed] [Google Scholar]
  29. Stanton P. E., Jr, Brown R., Rosenthal D., Clark M., Lamis P. A. External iliac artery occlusion by bicycle handle injury. J Cardiovasc Surg (Torino) 1986 Nov-Dec;27(6):728–730. [PubMed] [Google Scholar]
  30. Stonebridge P. A., Clason A. E., Duncan A. J., Nolan B., Jenkins A. M., Ruckley C. V. Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review. Br J Surg. 1989 May;76(5):515–516. doi: 10.1002/bjs.1800760527. [DOI] [PubMed] [Google Scholar]
  31. Talpos G., Horrocks M., White J. M., Cotton L. T. Plasmapheresis in Raynaud's disease. Lancet. 1978 Feb 25;1(8061):416–417. doi: 10.1016/s0140-6736(78)91205-9. [DOI] [PubMed] [Google Scholar]
  32. Volkman D. J., Mann D. L., Fauci A. S. Association between Takayasu's arteritis and a B-cell alloantigen in North Americans. N Engl J Med. 1982 Feb 25;306(8):464–465. doi: 10.1056/NEJM198202253060806. [DOI] [PubMed] [Google Scholar]
  33. Walker W. J., Giddings A. E. A protocol for the safe treatment of acute lower limb ischaemia with intra-arterial streptokinase and surgery. Br J Surg. 1988 Dec;75(12):1189–1192. doi: 10.1002/bjs.1800751214. [DOI] [PubMed] [Google Scholar]
  34. Welling R. E., Cranley J. J., Krause R. J., Hafner C. D. Obliterative arterial disease of the upper extremity. Arch Surg. 1981 Dec;116(12):1593–1596. doi: 10.1001/archsurg.1981.01380240073012. [DOI] [PubMed] [Google Scholar]
  35. Whelan T. J., Jr Management of vascular disease of the upper extremity. Surg Clin North Am. 1982 Jun;62(3):373–389. doi: 10.1016/s0039-6109(16)42731-3. [DOI] [PubMed] [Google Scholar]
  36. Williams S. J., 2nd Chronic upper extremity ischemia: current concepts in management. Surg Clin North Am. 1986 Apr;66(2):355–375. doi: 10.1016/s0039-6109(16)43887-9. [DOI] [PubMed] [Google Scholar]
  37. Yanni D., Wetzig N. R., Giddings A. E. Remote arterial injury. Another cause of spurious arterial spasm. J Cardiovasc Surg (Torino) 1989 Nov-Dec;30(6):948–950. [PubMed] [Google Scholar]
  38. van de Wal H. J., Skotnicki S. H., Wijn P. F., Lacquet L. K. Thoracic sympathectomy as a therapy for upper extremity ischemia. A long-term follow-up study. Thorac Cardiovasc Surg. 1985 Jun;33(3):181–187. doi: 10.1055/s-2007-1014113. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press

RESOURCES