As you age, it is not uncommon for plaque (a gummy substance made of cholesterol, calcium, and fibrous tissue) to build up on the inside of artery walls. As more plaque accumulates, the arteries begin to narrow and stiffen causing atherosclerosis, or hardening of the arteries. When enough plaque builds up to interfere with blood flow, arterial disease of the arm or other types of PAD can develop.
Symptoms of Arterial Disease of the ArmAt the onset of arterial disease of the arm, it is common for no symptoms to present. When symptoms do present, the most common one is called intermittent claudication (IC). IC is a temporary pain in your arm or hand on exertion that disappears when the arm is at rest. Everyday tasks, such as washing your hair or lifting your arms above your head, can trigger IC. Although pain is most commonly associated with IC, tightness, heaviness, cramping, or weakness can also occur.
As arterial disease of the arm progresses, one or more of the following symptoms may occur:
- Pain in the fingers, particularly at rest or when lying flat
- Sensitivity to cold on the skin
- Blue, pale, and/or cool skin on the fingers, hand, or arm
- Absence of a pulse in the wrist or hand
- Blue, slow-growing fingernails
- Slow-growing hair on the arm
- Sores on the fingers, hand, or arm
- Gangrene in the arm or hand (in extremely severe cases)
Causes & Risk Factors
The most common cause of arterial disease of the arm is atherosclerosis. Less commonly, other conditions may cause arterial disease of the arm, including:
- Buerger’s disease, a chronic inflammation of blood vessels and nerves in the hands and feet
- Raynaud’s disease, extreme sensitivity to cold resulting in numb and/or discolored skin on the fingers and toes
- Autoimmune diseases such as lupus, scleroderma, rheumatoid arthritis, and Takayasu’s disease
- Thoracic outlet syndrome
- Embolism, a blood clot that travels through the bloodstream and blocks a blood vessel in the arm
In rarer instances, the following can cause arterial disease of the arm:
- Radiation therapy for breast cancer
- A repeated injury
Tests Used to Diagnose Arterial Disease of the ArmIf your doctor suspects that you have arterial disease of the arm, he or she will seek a diagnosis by surveying your general health, inquiring about your medical history and possible risk factors, and asking you to describe your symptoms and how often they occur. This discussion is typically followed by a physical exam.
Your physical exam will include blood pressure measurements in both arms. If the results indicate a significantly lower pressure in one arm, a blockage in the artery of that arm is probable. Additionally, your doctor will take your pulse on the arm with the suspected blockage to determine if it is weak or absent.
To provide a firm diagnosis of arterial disease of the arm, your doctor may perform additional tests, such as chest and neck X-rays and segmental blood pressures. Other traditional tests include:
An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels and to assess the blood flow within the vessels.
Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels.
MR Angiography (MRA)
MRA is an imaging procedure that combines magnetic rays and computer technology to produce detailed images of the blood vessels.
Contrast Arteriography (Arteriogram)
This is an invasive procedure that provides a more detailed view of the blood vessels and can determine the specific location of blockages. When performing an angiogram, a special dye [properly referred to as contrast] is injected into the blood vessels through a catheter, making arteries visible on an X-ray. During contrast arteriography, it is common for procedures such as angioplasty or stent repairs to be performed as well.
Treatments for Arterial Disease of the ArmBased on the cause, location, and severity of your condition, the best course of treatment will be determined by your doctor. If you have existing conditions, such as high blood pressure, Raynaud’s disease, or Buerger’s disease, your doctor may first treat these conditions with medication and/or lifestyle changes.
Treatments for arterial disease of the arm include:
Sympathetic Block & Cervical Sympathectomy
A sympathetic block is an anesthetic injection that may relieve symptoms of arterial disease of the arm by blocking specific nerves in the hands. If the sympathetic block is successful, your doctor may follow up with cervical sympathectomy, which can be done surgically or by chemical injection to interrupt the nerves that cause spasms in your arm arteries.
An angioplasty is a minimally invasive procedure that helps improve the circulation in your arm. During an angioplasty, a hollow needle will be inserted into your artery and a special balloon attached to a catheter will be threaded through the needle to reach the blockage within the blood vessel. Once this device reaches the desired location, the balloon is then inflated to widen the artery walls. In some cases, a permanent stent (a tube made of metal mesh) is placed into the narrowed area of the artery to keep it open and allow for unobstructed blood flow.
For extensive blockages, a more invasive procedure called bypass surgery may be required. In bypass surgery, a graft is inserted into the artery above the blockages and then attached to the arm arteries. This creates a detour around the blockages and restores blood flow to the arm. The long-term success of bypass surgery can extend ten years or more.
An endarterectomy is a procedure used to remove plaque buildup on the artery walls, which can restore blood flow to the arm. During the procedure, your vascular surgeon opens the affected artery to remove the plaque buildup on the arterial lining and then repairs the artery with a stitch or graft.
If your arterial disease of the arm is secondary to Thoracic Outlet Syndrome, surgical options may be required. Your doctor will help determine the best treatment option in these cases.
In spite of multiple treatment options for arterial disease of the arm, it has no cure, so your doctor will recommend lifestyle changes to help minimize your risk factors. These include:
- Quitting smoking
- Maintaining a healthy weight
- Eating a healthy diet low in saturated fat and calories
- Controlling cholesterol levels
- Exercising regularly