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Chronic atherosclerotic upper limb ischaemia 

Chronic atherosclerotic upper limb ischaemia
Chapter:
Chronic atherosclerotic upper limb ischaemia
Author(s):

Colin D. Bicknell

and Mohamad S. Hamady

DOI:
10.1093/med/9780199658220.003.0033
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date: 23 September 2019

Symptomatic peripheral arterial disease in the upper limb is significantly less common than that below the diaphragm, but is nonetheless just as challenging. Ischaemic symptoms occur not only in the hand and arm, but also due to disturbances in flow in the cerebral and coronary artery territories. Both open surgical and minimally-invasive options exist for treating symptomatic disease. For proximal subclavian artery lesions, open surgical anatomical bypass and direct endarterectomy have largely been replaced by extra-anatomical approaches, such as carotid subclavian bypass and axillo-axillary bypass as the mortality from these approaches is significantly lower. More recently, endovascular approaches have been developed to avoid some of these risks. Whilst there is a theoretical concern that endovascular approaches may lead to embolic events via the vertebral artery, the reported results of these procedure are excellent. This chapter discusses the various clinical syndromes associated with upper limb atherosclerotic disease and the treatment options available.

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