Digital ischemia of the upper limb:Our systematic treatment protocol

Abstract

Upper limb digital ischemia is an unusual clinical entity.In this study we present the subject of digital ischemia of the upper limb and our systematic treatment protocol approach. INTRODUCTION Symptomatic upper extremity digital ischemia is an uncommon disorder reflecting diverse etiologies (1). The evaluation and treatment of our practical application for digital ischemia is demonstrated through illustrative cases. The relative rarity of vascular disorders of the arm accounts for unfamiliarity with upper extremity diagnostic testing on the part of even experienced vascular clinicians (2). Upperextremity digital ischemia needs a high index of suspicion in cases with unknown or unproven primary focus of the emboli. Prompt recognition and early consultation seem necessary to prevent or reduce the extent of the amputation (3). CASE PRESENTATION One of our cases was a 72-year-old male who had undergone coronary bypass surgery 7 years ago at our institution. He was admitted to our clinic with complaints of discoloration and pain in the 2 finger of his left hand, started 5 days ago (Figure 1). Figure 1 Figure 1 His physical examination revealed that all the peripheral pulses were palpable. Clinical examination shows a negative Allen test. His serological tests identified no pathological finding. Duplex scanning revealed no proximal source of emboli and arterial obstruction sign. Transthoracic echocardiography showed no cardiac foci for peripheral emboli. Avoidance of cold and other conservative treatment modalities were initiated. Our medical treatment strategy was as follows: Digital ischemia of the upper limb:Our systematic treatment protocol