Vascular insufficiency Discussion

Vascular insufficiency of the upper extremity is less common than lower extremity disease, but may be more incapacitating. Inadequate blood supply may result in pain, weakness, stiffness, nerve-related symptoms and generalized difficulty with the use of the hand. Risk of infection is increased. Ulceration or gangrene may develop, particularly when nerve function is impaired. Blood vessel disease may be spontaneous, may be associated with systemic diseases such as arteriosclerosis, diabetes, raynaud's, scleroderma, tobacco addiction, heart disease, or may follow a variety of injuries. Evaluation may require special tests such as doppler imaging or angiography. Treatment must be individualized, but generally involves the following:

stop smoking

medications to thin the blood or open up blood vessels

avoid cold exposure

control aggravating medical diseases

consider surgery to bypass areas of blockage or open up narrow areas

The overall outlook is best for patients who have a local correctable problem at the wrist level or higher up the arm. Outlook is worse in the context of underlying contributing medical problems, those who cannot quit smoking, patients having blood vessel disease over a wide area, or lack of normal vessels in the fingers into which blood may flow.

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