Kobinia G S, Olbert F, Russe O J, Denck H
Cardiovasc Intervent Radiol. 1980;3(1):25-41. doi: 10.1007/BF02551960.
The major chronic vascular diseases of the upper extremity are (1) subclavian artery occlusions, (2) thoracic outlet syndrome, and (3) angiospastic disease of the hand. Central subclavian artery lesions ease of the hand. Central subclavian artery lesions can have either hemodynamic consequences (subclavian steal syndrome) or, by peripheral embolization, can provoke ischemic symptoms of the hand. Costoclavicular narrowing can cause functional or fixed stenosis of the subclavian artery and can also involve the vein or brachial plexus. Symptoms due to pressure on the brachial plexus are most frequent, but embolization to the peripheral vessels may also occur. Angiospastic disease, the most frequent lesion of upper extremity vessels, comprises three types: Raynaud's disease, in which there are intermittent attacks of coldness and discoloration without evidence of occlusion on the angiogram; asphyxia manus et digitorum in which the attacks are also intermittent but there is morphologic evidence of occlusion; and digitus moriens or mortuus, in which there is a painful, permanent discoloration. All investigations of chronic vascular disease of the upper extremity should begin with arch aortography and then proceed to a selective catheterization of the vessels that are presumed to be involved.
（1）锁骨下动脉闭塞；（2）胸廓出口综合征；（3）手部血管痉挛性疾病。锁骨下动脉中央病变会影响手部。锁骨下动脉中央病变可产生血流动力学后果（锁骨下动脉盗血综合征），或通过外周栓塞引发手部缺血症状。肋锁狭窄可导致锁骨下动脉功能性或固定性狭窄，也可累及静脉或臂丛神经。臂丛神经受压引起的症状最为常见，但也可能发生外周血管栓塞。血管痉挛性疾病是上肢血管最常见的病变，包括三种类型：雷诺病，表现为间歇性发冷和变色，血管造影无闭塞证据；手足发绀症，发作也是间歇性的，但有闭塞的形态学证据；以及死指，表现为疼痛性、永久性变色。所有上肢慢性血管疾病的检查都应首先进行主动脉弓造影，然后对推测受累的血管进行选择性导管插入术。
