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Overview of surgical and endovascular techniques for upper extremity revascularization

Carlos Bechara, MD, MS
Neal R Barshes, MD, MPH
Jonathan D Gates, MD, MBA
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. Acute arterial disease, particularly acute embolism and trauma, are more common than chronic disorders of the upper extremity arterial system. The most common etiologies of chronic upper extremity ischemia are atherosclerotic disease and late stenosis or aneurysm related to a prior, perhaps initially missed, traumatic injury. Other less common etiologies, such as arterial thoracic outlet syndrome (with or without poststenotic aneurysm) and upper extremity aneurysm, may indicate the need for upper extremity revascularization.

The surgical and endovascular techniques used to treat the more common upper extremity arterial disorders will be reviewed here. Diseases associated with the need for upper extremity revascularization are reviewed briefly below and are presented in more detail in linked topic reviews. (See 'Indications' below.)


The main indications for upper extremity revascularization are acute limb ischemia, typically due to traumatic upper extremity injury or embolism, and chronic extremity ischemia from arterial stenosis, most commonly related to atherosclerotic disease, and leading to ischemic pain or tissue loss [1-3]. The clinical features and diagnosis of acute and chronic upper extremity ischemia are reviewed separately. (See "Overview of acute arterial occlusion of the extremities (acute limb ischemia)" and "Overview of upper extremity peripheral artery disease".)

Upper extremity arterial diseases that may indicate surgical or endovascular upper extremity revascularization include:

Upper extremity embolism – Embolism from the heart (thrombus, valvular vegetations, cardiac tumor) more commonly affects the lower extremities, but embolism to the upper extremity can and does occur with notable frequency. Emboli to the more distal upper extremity may also originate from upper extremity aneurysms or high-grade arterial stenoses. Emboli typically lodge at branch points, most commonly at the brachial trifurcation and occasionally at the take-off of the profunda brachii, both of which are amenable to embolectomy (figure 1). (See "Overview of acute arterial occlusion of the extremities (acute limb ischemia)" and 'Embolectomy' below.)


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Literature review current through: Sep 2016. | This topic last updated: Sep 17, 2015.
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