Arm Ischemia - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Upper limb (that includes arm, wrist, and hand) ischemia is less common than lower limb ischemia (that includes leg, ankle, and foot), and fewer cases have been reported for upper limb ischemia. On the other hand, delays in diagnosis and treatment are likely to cause significant functional impairment and disability.

The shoulder and elbow are significantly more tolerant of ischemia in a clinical environment due to their well-developed collateral circulation. Collateral circulation is the alternate blood supply around a blocked artery or vein through another route, such as adjacent minor vessels. As a result, ischemia symptoms are more likely to occur in the areas below the elbow.

What Is Arm Ischemia?

Ischemia is a dangerous condition characterized by inadequate blood flow and oxygen supply to the arms. It results from the narrowing or blockage of arteries that supply blood to the arm. Ischemia is a serious illness that can result in severe tissue damage and loss of the arm. Therefore, it is necessary to have the proper medical care.

What Are the Types of Arm Ischemia?

Ischemia can be acute or chronic, depending on the onset of ischemia.

• Acute Ischemia: This type of ischemia occurs suddenly.

• Chronic Ischemia: This type of ischemia does not occur suddenly. It develops gradually when the tissues do not get enough oxygen to meet their requirements. Furthermore, it persists for a longer duration.

What Are the Symptoms of Ischemia?

The symptoms of ischemia are listed below:

• Non-healing wounds.

• The pale appearance of the limb.

• Pain.

• Abnormal sensation in the limb.

• Paralysis.

• Cold limbs (perishingly cold).

• Pulselessness.

What Are the Causes of Arm Ischemia?

There are many causes of arm ischemia, including scleroderma, rheumatoid arthritis, systemic lupus, and other autoimmune or connective tissue diseases. However, according to a study conducted in 2015 on upper limb ischemia, the causes of both acute and chronic ischemia are listed below:

1. Acute Ischemia:

For acute ischemia, the causes are:

• Embolism From Heart Origin: An embolus is an unattached mass that travels through the blood and is responsible for creating blockages. An embolus from the heart region can create ischemia in the arm.

• Trauma: Trauma can also obstruct the blood vessels and can cause ischemia.

• Embolus From the Aortic Arch: The embolus can also come from the aortic arch. The aortic arch is the upper portion of the main artery that transports blood away from the heart.

2. Chronic Ischemia:

Chronic ischemia is caused by some diseases, which are listed below:

• Raynaud’s disease: Raynaud's disease causes some parts of the body, like fingers and toes, to become numb and chilled in reaction to cold weather or stress. In addition, Raynaud disease causes the narrowing of the arteries that carry blood to the skin, which results in decreased blood flow to affected areas. Therefore, patients with this disease are at risk of having ischemia.

• Buerger's disease: Buerger's disease, also known as thromboangitis obliterans, causes the blood vessels to be inflamed, swollen, and significantly obstructed by blood clots. Therefore, this disease can also become the cause of ischemia.

• Atherosclerosis: Atherosclerosis is a condition that results from the thickening or hardening of the arteries caused by plaque build-up in the artery's inner lining. These plaque build-ups can block the arteries and reduce the blood supply resulting in ischemia.

• Thoracic outlet syndrome: Thoracic outlet syndrome (TOS) is a disorder in which nerves, arteries, or veins in the route from the lower neck to the armpit get compressed. As in this syndrome, compression of arteries occurs, and there may be a chance of ischemia.

Apart from these causes, sometimes chronic ischemia can occur without any underlying reason, and its reason remains unknown.

Which Blood Vessels Get Affected Most by Upper Limb Ischemia?

In upper limb ischemia, including the arm, the following blood vessels get affected the most:

• Brachial Artery: The brachial artery is the main blood vessel that delivers oxygen and nutrients to the upper arm, elbow, forearm, and hand.

• Subclavian Artery: The subclavian artery is a major blood vessel that delivers blood to the upper limbs and regions of the head and neck.

• Ulnar Artery: The ulnar artery is the major blood vessel carrying oxygenated blood to the medial side of the forearm.

• Radial Artery: A branch of the brachial artery, the major blood vessel in the upper arm, is the radial artery.

• Axillary Artery: The axillary artery is a major blood vessel that transports oxygenated blood to the lateral side of the thorax, the axilla (armpit), and the upper limb.

• Palmar Arterial Arch: These arteries supply blood to the hands.

• Innominate Artery: They deliver blood to the head, neck, and upper extremities.

How Is Arm Ischemia Diagnosed?

The following methods can diagnose arm ischemia:

• Taking the history of the patient (any previous episode of heart attack or any other illness).

• Physical examination.

• Computerized tomography (CT) angiography.

• Conventional angiography.

• Duplex ultrasound.

What Is the Treatment of Upper Arm Ischemia?

Treatment involves conservative treatment and surgical procedures. The treatment options are listed below:

1. Conventional Treatment: Conservative treatment treats ischemia without any surgical intervention. This approach involves medications, injections, and lifestyle modifications. In addition, risk factor adjustments, such as smoking cessation, blood pressure control, adequate glycemic control (for diabetes), and cholesterol reduction, should be implemented. Aspirin-based antiplatelet medication has been proven to significantly lower the risk of heart attack, stroke, and death in patients with peripheral vascular disease and the recurrence of blockage after angioplasty.

2. Surgical Treatments:

• Embolectomy or thrombectomy.

• Bypass surgery.

• Thrombolysis (percutaneous catheter-directed thrombolysis).

• Primary repair.

What Are the Complications After Treatment of Upper Arm Ischemia?

The complications after the treatment are listed below:

• Bleeding.

• Acute renal failure (kidney failure).

• Infection of the wound.

• Minor amputation of the limb.

• Recurrence after the surgery.

Conclusion

Arm ischemia, which comes under upper limb ischemia, is a very rare type of limb ischemia. Arm ischemia can occur suddenly referred acute, and can be of longer duration termed chronic. Acute arm ischemia typically requires intervention and is frequently caused by thromboembolic diseases, trauma, or iatrogenic injury. Arm ischemia can be life-threatening and cause death if not treated on time.