RT Book, Section A1 Hart, Joseph P. A1 Davies, Mark G. A2 Nazzal, Munier A2 Blebea, John A2 Osman, Mohamed F. SR Print(0) ID 1200678152 T1 Chronic Upper Extremity Ischemia T2 Vascular and Endovascular Surgery: Clinical Diagnosis and Management YR 2024 FD 2024 PB McGraw Hill PP New York, NY SN 9781260462715 LK accesssurgery.mhmedical.com/content.aspx?aid=1200678152 RD 2024/03/29 AB Chronic limb-threatening ischemia in the upper extremity, and in particular, chronic hand ischemia is relatively unusual and arterial occlusions are often an incidental finding on physical, ultrasonic, or arteriographic examination.1 The presence of rich collateral networks, small muscle mass, and ease of adaptation of activity of the upper extremity mitigates against symptomatic disease. For management purposes of, occlusive disease of the upper limb arteries can be classified as above-the-elbow arteries (innominate, subclavian, axillary, and humeral) or below-the-elbow arteries (radial, ulnar, interosseous, and hand arteries).2,3 Compared with lower extremity ischemia, direct reconstruction of upper extremity arterial occlusive disease constitutes less than 4% of all vascular bypass procedures and as a result, there is limited data available on outcomes.4,5 It has been estimated that only 5% of patients with limb ischemia have symptomatic involvement of the upper extremity.6 Chronic critical ischemia of the hand due to atherosclerotic disease is rare but is a disabling condition.1 Below elbow disease is a frequent problem in diabetics mirroring the problem in the lower extremities. The majority of the literature on digital ischemia has concentrated on nonatherosclerotic occlusive disease of the hand. Porter and Taylor7 demonstrated that small arterial occlusive disease of the palmar and digital arteries due to diverse causes, is a frequent cause of upper extremity ischemia.