ABSTRACT
All physicians who treat vascular disease encounter occasional patients with fixed or intermittent upper extremity ischemia, a group estimated to comprise about 5% of patients with limb ischemia. A large majority of patients with upper extremity ischemia complaints have only intermittent vasospasm of the hands and fingers, a condition termed Raynaud’s syndrome (RS). An estimated 5-10% of patients with upper extremity ischemia symptoms have severe hand and finger ischemia or digital ischemia ulceration associated with fixed arterial occlusive disease of the palmar and digital arteries. Only a small percentage of these patients develop distal arterial occlusion as a result of potentially correctable arterial obstruction at or proximal to the wrist, including proximal subclavian and innominate atherosclerosis, subclavian aneurysms with or without a coexistent cervical rib, subclavian and upper extremity giant cell arteritis, radiation arteritis, and associated disorders.[1-3] In our practice, an estimated 90-95% percent of patients with fixed arterial occlusive disease of the palmar and digital circulation develop the condition as a complication of arteritis accompanying one or more of a variety of systemic disease processes and not as a complication of a proximal arterial occlusive disease with distal embolization.
