Upper Extremity Arterial Disease

Abstract

Historically, upper extremity arterial disease has not garnered the same attention from physicians as arterial disease of the lower extremities. Compared to atherosclerotic arterial disease of the lower extremities, clinically significant atherosclerosis of the upper extremities is far less common. When present, however, upper extremity arterial disease can cause substantial patient limitation and morbidity. Furthermore, upper extremity atherosclerotic arterial disease has been shown to carry similar rates of major adverse cardiovascular events compared to lower extremity arterial disease. Severe atherosclerosis of the left subclavian artery, innominate artery, or right subclavian artery in particular may manifest a spectrum of symptoms. In extreme cases, findings of advanced ischemia such as rest pain, ischemic ulcerations, or digit loss may be present, while in others, classic arm claudication or arm weakness may be seen. Subclavian steal syndrome, where dizziness or syncope results from retrograde flow through the ipsilateral vertebral artery (due to an occlusion which is proximal to the origin of the vertebral artery) during arm exertion, may also be present. On the other end of the spectrum, many patients may be asymptomatic and identified only after discrepant upper extremity blood pressures are noted.