Current diagnosis and management of upper extremity ischemia.

Although the causes of upper extremity ischemia are diverse, their management follows well established surgical principles in most instances. Evaluation that emphasizes precise physical examination and exploits simple noninvasive determinations aids in reducing cost and complexity. Subclavian occlusive lesions are optimally managed by bypass procedures that avoid thoracotomy. Occlusions in the arm may usually be treated with bypass grafts of reversed autogenous saphenous vein. Brachial artery occlusion after cardiac catheterization should be approached with early exploration, using local reconstruction of the artery if necessary. Vasospastic symptoms should be evaluated thoroughly in an attempt to identify their cause. Most often they may be treated with medications, singly or in combination. Sympathectomy is of benefit only in unusual instances, when no specific cause of the vasospastic symptoms can be found after prolonged evaluations.