Blood Vessels

  • Henk GieleEmail author
  • Richard Barton


Vascular disorders of the upper extremity encompass a broad range of pathology with diverse clinical presentations and management options. The consequences of vascular insufficiency may be critical to the point of producing cell death or subcritical events that damage tissue but fall short of generating necrosis. They occur as a result of a structural abnormality (laceration, thrombosis, embolism) or as a consequence of inappropriate physiological control mechanisms or both. Ultimately any symptoms that are a consequence of vascular disorders result from a failure to provide adequate nutritional blood flow to the extremity.


Vascular injuries hand and upper limb ischemia 


  1. 1.
    Gupta C, et al. A morphological study of variations in the branching pattern and termination of the radial artery. Singapore Med J. 2012;53(3):208–11.PubMedGoogle Scholar
  2. 2.
    Ramirez AR, Gonzalez SM. Arteries of the thumb: description of anatomical variations and review of the literature. Plast Reconstr Surg. 2012;129(3):468e–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Singla RK, Kaur N, Dhiraj GS. Prevalence of the persistant median artery. J Clin Diagn Res. 2012;6(9):1454–7.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Imanishi N, Nakajima H, Aiso S. Anatomic study of the venous drainage architecture of the forearm skin and subcutaneous tissue. Plast Reconstr Surg. 2000;106(6):1287–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 2007;119(6):1813–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 2007;120(4):982–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Puttarajappa C, Rajan DS. Images in clinical medicine. Allen’s test. N Engl J Med. 2010;363(14):e20.PubMedCrossRefGoogle Scholar
  8. 8.
    Reimer P, Landwehr P. Non-invasive vascular imaging of peripheral vessels. Eur Radiol. 1998;8(6):858–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Zweifler AJ, Trinkaus P. Occlusive digital artery disease in patients with Raynaud’s phenomenon. Am J Med. 1984;77(6):995–1001.PubMedCrossRefGoogle Scholar
  10. 10.
    Sitzmann JV, Ernst CB. Management of arm arterial injuries. Surgery. 1984;96(5):895–901.PubMedGoogle Scholar
  11. 11.
    Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001;33(6):1212–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Shanmugam V, et al. Management of upper limb arterial injury without angiography – Chennai experience. Injury. 2004;35(1):61–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Cikrit DF, et al. An experience with upper-extremity vascular trauma. Am J Surg. 1990;160(2):229–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Aftabuddin M, et al. Management of isolated radial or ulnar arteries at the forearm. J Trauma. 1995;38(1):149–51.PubMedCrossRefGoogle Scholar
  15. 15.
    Meharwal ZS, Trehan N. Functional status of the hand after radial artery harvesting: results in 3,977 cases. Ann Thorac Surg. 2001;72(5):1557–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Gates JD, Knox JB. Axillary artery injuries secondary to anterior dislocation of the shoulder. J Trauma. 1995;39(3):581–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Ebraheim NA, et al. Scapulothoracic dissociation (closed avulsion of the scapula, subclavian artery, and brachial plexus): a newly recognized variant, a new classification, and a review of the literature and treatment options. J Orthop Trauma. 1987;1(1):18–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Dormans JP, Squillante R, Sharf H. Acute neurovascular complications with supracondylar humerus fractures in children. J Hand Surg Am. 1995;20(1):1–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Garbuz DS, Leitch K, Wright JG. The treatment of supracondylar fractures in children with an absent radial pulse. J Pediatr Orthop. 1996;16(5):594–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Shaw BA, et al. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma. 1990;4(1):25–9.PubMedCrossRefGoogle Scholar
  21. 21.
    White L, Mehlman CT, Crawford AH. Perfused, pulseless, and puzzling: a systematic review of vascular injuries in pediatric supracondylar humerus fractures and results of a POSNA questionnaire. J Pediatr Orthop. 2010;30(4):328–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Keen RR, et al. Autogenous vein graft repair of injured extremity arteries: early and late results with 134 consecutive patients. J Vasc Surg. 1991;13(5):664–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Guyton GP, Shearman CM, Saltzman CL. Compartmental divisions of the hand revisited. Rethinking the validity of cadaver infusion experiments. J Bone Joint Surg Br. 2001;83(2):241–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Taylor RM, Sullivan MP, Mehta S. Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk. Curr Rev Musculoskelet Med. 2012;5(3):206–13.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Matsen 3rd FA, Winquist RA, Krugmire Jr RB. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. 1980;62(2):286–91.PubMedGoogle Scholar
  26. 26.
    Kalyani BS, et al. Compartment syndrome of the forearm: a systematic review. J Hand Surg Am. 2011;36(3):535–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Garg K, et al. Open surgical management of complications from indwelling radial artery catheters. J Vasc Surg. 2013;58:1325–30.PubMedCrossRefGoogle Scholar
  28. 28.
    Larsen BT, et al. Surgical pathology of hypothenar hammer syndrome with new pathogenetic insights: a 25-year institutional experience with clinical and pathologic review of 67 cases. Am J Surg Pathol. 2013;37:1700–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Rutherford RB, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–38.PubMedCrossRefGoogle Scholar
  30. 30.
    Wheatley MJ, Marx MV. The use of intra-arterial urokinase in the management of hand ischemia secondary to palmar and digital arterial occlusion. Ann Plast Surg. 1996;37(4):356–62; discussion 362–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Bedford RF, Wollman H. Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology. 1973;38(3):228–36.PubMedCrossRefGoogle Scholar
  32. 32.
    Valentine RJ, Modrall JG, Clagett GP. Hand ischemia after radial artery cannulation. J Am Coll Surg. 2005;201(1):18–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Maiman MH, Bookstein JJ, Bernstein EF. Digital ischemia: angiographic differentiation of embolism from primary arterial disease. AJR Am J Roentgenol. 1981;137(6):1183–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Arquilla B, et al. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med. 2000;19(2):139–43.PubMedCrossRefGoogle Scholar
  35. 35.
    Andreev A, et al. Severe acute hand ischemia following an accidental intraarterial drug injection, successfully treated with thrombolysis and intraarterial Iloprost infusion. Case report. Angiology. 1995;46(10):963–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Sen S, Chini EN, Brown MJ. Complications after unintentional intra-arterial injection of drugs: risks, outcomes, and management strategies. Mayo Clin Proc. 2005;80(6):783–95.PubMedCrossRefGoogle Scholar
  37. 37.
    Harris Jr EJ, et al. Surgical treatment of distal ulnar artery aneurysm. Am J Surg. 1990;159(5):527–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Nehler MR, et al. Upper extremity ischemia from subclavian artery aneurysm caused by bony abnormalities of the thoracic outlet. Arch Surg. 1997;132(5):527–32.PubMedCrossRefGoogle Scholar
  39. 39.
    Siddiqui MU, Khurram D, Elder M. Management of brachial artery thrombosis post catheterization. J Invasive Cardiol. 2013;25(3):E60–2.PubMedGoogle Scholar
  40. 40.
    Arshad A, McCarthy MJ. Management of limb ischaemia in the neonate and infant. Eur J Vasc Endovasc Surg. 2009;38(1):61–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Coombs CJ, et al. Brachial artery thrombosis in infants: an algorithm for limb salvage. Plast Reconstr Surg. 2006;117(5):1481–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Herrick AL. Pathogenesis of Raynaud’s phenomenon. Rheumatology (Oxford). 2005;44(5):587–96.CrossRefGoogle Scholar
  43. 43.
    Pyykko I, Gemne G. Pathophysiological aspects of peripheral circulatory disorders in the vibration syndrome. Scand J Work Environ Health. 1987;13(4):313–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Gemne G, et al. The Stockholm Workshop scale for the classification of cold-induced Raynaud’s phenomenon in the hand-arm vibration syndrome (revision of the Taylor-Pelmear scale). Scand J Work Environ Health. 1987;13(4):275–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Doll DC, Ringenberg QS, Yarbro JW. Vascular toxicity associated with antineoplastic agents. J Clin Oncol. 1986;4(9):1405–17.PubMedGoogle Scholar
  46. 46.
    Wigley FM, et al. Anticentromere antibody as a predictor of digital ischemic loss in patients with systemic sclerosis. Arthritis Rheum. 1992;35(6):688–93.PubMedCrossRefGoogle Scholar
  47. 47.
    Anderson ME, et al. Computerized nailfold video capillaroscopy–a new tool for assessment of Raynaud’s phenomenon. J Rheumatol. 2005;32(5):841–8.PubMedGoogle Scholar
  48. 48.
    Landry GJ. Current medical and surgical management of Raynaud’s syndrome. J Vasc Surg. 2013;57(6):1710–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud’s phenomenon. J Hand Surg Am. 2009;34(3):446–52.PubMedCrossRefGoogle Scholar
  50. 50.
    Tomaino MM, Goitz RJ, Medsger TA. Surgery for ischemic pain and Raynaud’s phenomenon in scleroderma: a description of treatment protocol and evaluation of results. Microsurgery. 2001;21(3):75–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Kotsis SV, Chung KC. A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia. J Rheumatol. 2003;30(8):1788–92.PubMedGoogle Scholar
  52. 52.
    Beathard GA, Spergel LM. Hand ischemia associated with dialysis vascular access: an individualized access flow-based approach to therapy. Semin Dial. 2013;26(3):287–314.PubMedCrossRefGoogle Scholar
  53. 53.
    Aimaq R, Katz SG. Using distal revascularization with interval ligation as the primary treatment of hand ischemia after dialysis access creation. J Vasc Surg. 2013;57(4):1073–8; discussion 1078.PubMedCrossRefGoogle Scholar
  54. 54.
    Bogoch ER, Gross DK. Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol. 2005;32(4):642–8.PubMedGoogle Scholar
  55. 55.
    Stone JH. Polyarteritis nodosa. JAMA. 2002;288(13):1632–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Dargon PT, Landry GJ. Buerger’s disease. Ann Vasc Surg. 2012;26(6):871–80.PubMedCrossRefGoogle Scholar
  57. 57.
    Warner PM, et al. Current management of purpura fulminans: a multicenter study. J Burn Care Rehabil. 2003;24(3):119–26.PubMedCrossRefGoogle Scholar
  58. 58.
    Numanoglu A, et al. Meningococcal septicaemia complications involving skin and underlying deeper tissues–management considerations and outcome. S Afr J Surg. 2007;45(4):142–6.PubMedGoogle Scholar
  59. 59.
    Miedema A, et al. Improving outcome in meningococcal disease: don’t forget compartment syndrome! Pediatr Crit Care Med. 2008;9(3):e20–2.PubMedCrossRefGoogle Scholar
  60. 60.
    Penington AJ, Craft RO, Tilkorn DJ. Plastic surgery management of soft tissue loss in meningococcal septicemia: experience of the Melbourne Royal Children’s Hospital. Ann Plast Surg. 2007;58(3):308–14.PubMedCrossRefGoogle Scholar
  61. 61.
    Tzamaloukas AH, et al. Hand gangrene in diabetic patients on chronic dialysis. ASAIO Trans. 1991;37(4):638–43.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Plastic Reconstructive and Hand SurgeryOxford University HospitalsOxfordUK
  2. 2.Plastic and Reconstructive Surgery UnitThe Royal Melbourne HospitalMelbourneAustralia

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