Upper limb ischemia

Def.

Etiology

  1. Atherosclerosis: This is the most common cause of upper limb ischemia. Atherosclerosis, which is the buildup of plaque in the arteries, can lead to narrowing or blockage of the arteries supplying blood to the upper limbs.
  1. Embolism: Embolism occurs when a blood clot, air bubble, or other substance travels through the bloodstream and lodges in an artery, obstructing blood flow. Embolism can be caused by a variety of factors, such as atrial fibrillation, heart valve disease, or atherosclerosis.
  1. Thrombosis: Thrombosis is the formation of a blood clot inside an artery, which can obstruct blood flow. Thrombosis can be caused by various factors, such as injury to the artery, infection, or inflammation.
  1. Vasospasm: Vasospasm is the narrowing of the arteries due to constriction of the smooth muscle in the artery walls. This can be caused by factors such as cold exposure, medications, or underlying medical conditions such as Raynaud's disease.
  1. Trauma: Trauma to the upper limbs, such as fractures, dislocations, or crush injuries, can lead to damage to the blood vessels and result in upper limb ischemia.
  1. Radiation therapy: Radiation therapy to the chest or upper abdomen can damage the blood vessels in the upper limbs, leading to ischemia.
  1. Infection: Infection of the blood vessels, such as septic arthritis or osteomyelitis, can lead to inflammation and narrowing of the arteries, resulting in upper limb ischemia.
  1. Rare genetic disorders: Certain rare genetic disorders, such as Takayasu's arteritis or fibromuscular dysplasia, can cause narrowing or blockage of the arteries, leading to upper limb ischemia.

Diagnosis

Investigations

CP
vary depending on the underlying cause and severity of the condition and can help to identify the location and severity of the ischemia.

  1. Pain: Pain is the most common symptom of upper limb ischemia. It can be described as cramping, aching, or burning, and may be exacerbated by movement or cold exposure.
  1. Numbness and tingling: particularly in the fingers and hand.
  1. Weakness: making it difficult to perform fine motor tasks.
  1. Coldness: particularly in the fingers and hand.
  1. Color changes: The affected limb may appear pale, bluish, or red, depending on the severity of the ischemia.
  1. Pulslessness
  1. Blood tests: can help to identify underlying medical conditions that may be contributing to the ischemia, such as diabetes, high cholesterol, or infection.
  1. Imaging studies: Imaging studies such as US, CT angiography, or MRI can help to identify the location and extent of the ischemia, as well as any underlying structural abnormalities in the blood vessels.
  1. Angiography: involves injecting contrast material into the blood vessels and imaging them with X-rays, can provide detailed information about the blood vessels and any blockages or narrowing.
  1. Doppler ultrasound: can be used to assess blood flow in the affected limb and identify any areas of reduced or absent flow.
  1. Arteriography: involves inserting a catheter into the affected artery and injecting contrast material to visualize the blood vessels and identify any blockages or narrowing.
  1. Tissue biopsy: In some cases, a tissue biopsy may be performed to help identify underlying conditions such as vasculitis or infection.

TTT
Depends on the underlying cause

  1. Medications: as aspirin, clopidogrel, and statins may be prescribed to help prevent blood clots, reduce inflammation, and lower cholesterol levels.
  1. Lifestyle changes: such as quitting smoking, exercising regularly, and maintaining a healthy weight can help to reduce the risk of developing upper limb ischemia.
  1. Angioplasty and stenting: involve using a catheter to open up narrowed or blocked arteries and inserting a stent to help keep the artery open. This procedure can help to improve blood flow to the affected limb.
  1. Bypass surgery: Bypass surgery involves creating a new path for blood flow around the blocked or narrowed artery. This procedure can help to improve blood flow to the affected limb and prevent further ischemia.
  1. Thrombolysis: involves using medications to dissolve blood clots and restore blood flow to the affected limb.
  1. Physical therapy: can help to improve strength, flexibility, and range of motion in the affected limb, as well as prevent further damage to the blood vessels.
  1. Compression therapy: therapy involves using compression garments or devices to help improve blood flow to the affected limb and prevent further ischemia.
  1. Surgery: In some cases, surgery may be necessary to remove damaged blood vessels or repair structural abnormalities in the blood vessels.

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