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Pathology of Upper Extremity Arterial Disease


Upper extremity arterial disease is relatively uncommon. Unlike lower extremity disease, where the cause is predominantly atherosclerotic and the patients older, upper extremity arterial pathology is far more diverse and often affects younger persons ( Box 1 ). Treatment modalities for these pathologies vary considerably, making a correct diagnosis imperative. Most patients complain of ischemic symptoms, though patients with aneurysmal disease occasionally experience symptoms related to compression of surrounding structures. As a result of the rich collateral network of the upper extremity and its relatively low workload compared to the lower extremity, patients complain of exercise-induced symptoms (fatigue, numbness, and/or paresthesias) less commonly than those with lower extremity disease.

BOX 1
Upper Extremity Arterial Pathology

Vasospasm

  • Idiopathic – Primary Raynaud’s syndrome (digital)

  • Ergot poisoning (brachial/radial/ulnar)

  • Drug-induced

  • Vasopressors (digital/palmar)

  • Cocaine (digital/palmar/radial/ulnar)

Intrinsic Arterial Disease

  • Atherosclerosis (innominate–subclavian)

  • Radiation arteritis (axillosubclavian)

  • Azotemic arteriopathy (radial/ulnar, palmar, digital)

Inflammatory Diseases

  • Takayasu’s disease (innominate, subclavian)

  • Giant cell arteritis (axillobrachial)

  • Buerger’s disease (thromboangiitis obliterans) (radial/ulnar, palmar, digital)

  • Connective tissue disorders (palmar/digital)

  • Systemic sclerosis (scleroderma) or CREST syndrome

  • Mixed connective tissue disease

  • Systemic lupus erythematosus

  • Rheumatoid arthritis

Aneurysms (subclavian most common)

Embolism

  • Cardiac (brachial)

  • Arterial source

  • Thoracic outlet syndrome (subclavian is source)

  • Peripheral aneurysm

  • Atheroembolism

  • Occluded graft

Trauma

  • Blunt or penetrating trauma

  • Iatrogenic

  • Cardiac catheterization (distal brachial)

  • Arterial monitoring lines (radial, brachial, axillary)

  • Occupational

  • Hypothenar hammer syndrome (ulnar)

  • Vibration (palmar/digital)

  • Sports or athletic injury (axillosubclavian)

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