Upper Extremity Arterial Occlusive Disease

Causes of upper extremity arterial occlusive disease

• Central embolic disease: Cardiac origin. Most commonly lodge in the brachial artery.
• Acute trauma:
• Hypothenar hammer syndrome: Repetitive trauma to the hypothenar area. Angiography may reveal focal ulnar artery aneurysm at the level of the hamate with segmental palmar ulnar artery occlusion and multiple digital artery occlusions. May also see the characteristic corkscrew elongation and ectasia of the ulnar artery. The superficial palmar arch is more often affected, but the deep palmar arch can also be involved.
• Thoracic outlet syndrome: Due to compression of the subclavian artery at the thoracic outlet, which may result in localized atheroma or aneurysm with embolization.
  
  
• Large and medium vessel vasculitis: Takayasu arteritis and giant cell arteritis. Involve large inflow and medium size proximal outflow arteries.
• Medium and small vessel vasculitis: Buerger disease (can also involve upper extremity veins), Behcet disease.
• Small-vessel vasculitis: Rheumatoid arthritis, Sjögren syndrome, Wegener granulomatosis, polyarteritis nodosa, scleroderma, systemic lupus erythematosus, polymyositis, dermatomyositis, mixed connective tissue disorders.

References

• Hellinger JC, Epelman M, Rubin GD. Upper extremity computed tomographic angiography: state of the art technique and applications in 2010. Radiol Clin North Am. 2010 Mar;48(2):397-421, ix.
• Maiman MH, Bookstein JJ, Bernstein EF. Digital ischemia: angiographic differentiation of embolism from primary arterial disease. AJR Am J Roentgenol. 1981 Dec;137(6):1183-7.