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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