MANAGEMENT OF SEVERE ISCHEMIA OF THE UPPER EXTREMITY

Ischemia of the upper extremity is unusual, particularly in patients w ithout trauma or iatrogenic injury to the vessels of the arm. Some aut hors have suggested that ischemia of the upper extremity is one sixth as common as that in the leg. Management of patients with vascular tra uma or iatrogenic injury is usually straightforward, with direct repai r or vein grafting of the injured vessel. Patients with ischemia from vascular disease, however, present a different set of management probl ems. These individuals often suffer from systemic medical problems tha t lead to their vascular disease, which is often very severe and accel erated because of the underlying cause. This article discusses the app roach to these patients and options for management.