Arm Artery Disease
What is arm artery disease?
Arm artery disease is an uncommon form of peripheral arterial disease (PAD). Most people with PAD have blocked leg arteries, called leg artery disease. Although arm artery disease can come on quickly, it usually starts slowly and gets worse over a long period of time. If you have mild arm artery disease, you may not notice any symptoms. As the disease advances, you may experience pain in the arm with activity and, if it becomes more severe, you eventually may develop sores or gangrene in your arm, in particular at the tips of your fingers. Gangrene is tissue death and occurs when tissues in your body do not receive enough oxygen and blood. Like other types of PAD, arm artery disease is usually caused by atherosclerosis, which means hardening of the arteries. As you age, a substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. In atherosclerosis, your arteries narrow or become blocked as plaque builds up on your artery walls.
What are the symptoms?
You may not feel any symptoms from mild arm artery disease. The most common initial symptom is intermittent claudication (IC). IC is discomfort or pain in your arms that happens when you are using your arm and goes away when you rest your arm muscles. Activities that can trigger IC include combing or washing your hair or lifting your arms above your head. You may not always feel pain; instead you may feel tightness, heaviness, cramping, or weakness in your arm. Other symptoms of arm artery disease include finger pain, sensitivity to cold in your hands, or fingers that turn blue or pale. As the disease gets worse, you may experience pale, cool skin on your arm or hand; blue, slow-growing fingernails; sores on your fingers; and, eventually, gangrene in your arm or hand.
What causes arm artery disease?
Atherosclerosis is the main cause of arm artery disease. However, several uncommon conditions that can also cause arm artery disease include: • Buerger’s disease, an inflammation of the small blood vessels and nerves in your hands and feet that usually affects smokers • Takayasu’s disease, an autoimmune disease that mostly affects young women. An autoimmune disease means that your immune system attacks your body's organs or tissues • Raynaud’s disease, in which your hands are extremely sensitive to cold and your fingers turn blue, white, and red in a cool environment • Diseases such as lupus, scleroderma, and rheumatoid arthritis • Thoracic outlet syndrome, which is sometimes associated with repetitive motions like pitching in major league baseball • Embolism, which is a blood clot that travels from one area of your body and blocks a blood vessel in your arm Rarely, frostbite, radiation therapy for breast cancer, and repeated injury, for example, to the pad of your hand, or other forms of injury, can cause arm artery disease. Arm artery disease is more likely to affect you if you smoke and are older than age 60. Other risk factors include having high cholesterol or high blood pressure.
What tests will I need?
First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. As part of your history, your physician will ask you if you smoke or have high blood pressure. Your physician will also want to know when and how often your symptoms occur, as well as their location. As part of your exam, your physician will take your blood pressure in both arms. If your blood pressure is significantly lower in one arm, that arm most likely has a blockage. Your physician will feel for a pulse below the suspected blockage. If you have arm artery disease, this pulse will be weak or even absent. Your physician will also listen to your arm arteries with a stethoscope. Abnormal whooshing sounds, called bruits, may suggest blood is flowing through a narrowed artery. After your exam, if your physician suspects arm artery disease, he or she may perform tests, such as:
- Segmental blood pressures, or taking several blood pressure readings along your arms, hands, and fingers
- Duplex ultrasound
- Chest or neck x-rays
- Computerized axial tomography (CT or CAT scan)
- Magnetic resonance angiography (MRA)
- Angiography (takes x-rays of your arteries)
How is arm artery disease treated?
Your treatment for arm artery disease will depend on the underlying cause, as well as the location and severity of any blockages. If you have high blood pressure, your physician may prescribe medications that treat those conditions. Some prescription medications may help Raynaud's disease. If you have Buerger’s disease, quitting smoking is the most important treatment.
Some physicians use an anesthetic injection, called a sympathetic block, to block certain nerves in the hands. If this procedure relieves your symptoms, your physician may recommend cervical sympathectomy. Cervical sympathectomy can be done surgically or sometimes by chemical injection. This procedure interrupts the nerves that cause your arteries to spasm.
If a large blood vessel in your arm is blocked, your physician may be able to treat it with an angioplasty procedure, depending upon the location and how much of the blood vessel is blocked. During an angioplasty procedure, which is sometimes performed at the same time as an angiogram, a long, thin, flexible tube, called a catheter, is inserted into a small puncture and is guided through your arteries to the blocked area. Once there, a special balloon attached to the catheter is inflated and deflated, several times if needed. The balloon stretches and widens the vessel. In some circumstances, a mesh-metal tube called a stent may be placed into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After successful angioplasty, blood flows more freely through your artery.
For more extensive blockages, you may need a surgical repair such as endarterectomy or bypass. An endarterectomy is a way for your surgeon to remove the plaque from your artery. To perform an endarterectomy, your vascular surgeon makes an incision and removes the plaque contained in the inner lining of the diseased artery. This leaves a wide-open artery and restores blood flow through it. To perform a bypass, your vascular surgeon creates a detour around your blocked artery with a synthetic tube or a vein from your body.
If the arm blood vessel blockage is associated with thoracic outlet syndrome, a surgical procedure to remove an extra rib or to relieve pressure on the vessel may be required.
The best choice of the treatment depends upon several considerations including your general health, the pattern and particular cause of the obstruction, and how much blockage that you have. Your vascular surgeon will help you determine which method of treatment is best for your particular situation.
Images reproduced by kind permission Vascular Web