Chronic Vascular Disorders of the Upper Extremity

Chronic symptomatic ischemia in the upper extremity is the result of blood flow that is nutritionally inadequate to fulfill metabolic requirements. Symptoms may also result from inappropriate thermoregulatory function. Ischemia may be secondary to inappropriate vessel response when vessels are unable to vasodilate in response to stress or inappropriate vasoconstriction (ie, vasospastic disease); intima/media injury resulting in aneurysm, embolism, and thrombosis (occlusive disease); or a combination of both (vaso-occlusive disease). Occlusive events may occur secondary to low-flow states in vasospastic disease that precipitate thrombosis development (ie, secondary occlusion) or secondary to ischemia from occlusive disease that may produce autonomic dysfunction and secondary vasospasm. This cross-over phenomenon creates difficulty in evaluation and management. The goal of this article is to assess contemporary methods of evaluation, classification, and management of upper extremity ischemia.