Angiographic diagnosis of acral circulatory disorders of the upper extremities

• Published in: Radiologe 2010-10, Vol.50 (10), p.879
• Main Authors: Deák, Z, Treitl, M, Reiser, M F, Degenhart, C
• Format: Article
• Language: ger
• Subjects: Angiography; Angiography, Digital Subtraction; Arm - blood supply; Arthritis, Rheumatoid - diagnostic imaging; Fingers - blood supply; Humans; Ischemia - diagnostic imaging; Lupus Erythematosus, Systemic - diagnostic imaging; Polyarteritis Nodosa - diagnostic imaging; Raynaud Disease - diagnostic imaging; Thromboangiitis Obliterans - diagnostic imaging; Vasculitis - diagnostic imaging
• ISSN: 1432-2102
• DOI: 10.1007/s00117-010-2005-x

Acral ischemic lesions rarely affect the upper extremities. While in the lower limbs atherosclerosis is responsible for the majority of lesions, vasculitis and autoimmune diseases play an important role in the pathogenesis of ischemic lesions of the upper limbs. A considerable number of acral circulatory disorders present with Raynaud's phenomenon and often without associated necrosis. Raynaud's phenomenon is mainly idiopathic but may also be secondary to underlying conditions, such as autoimmune diseases and vasculitis. Because of its high spatial resolution and the often discrete morphological findings digital subtraction angiography (DSA) is still an important diagnostic method in the radiological evaluation of acral circulatory disorders of the hand. Angiographic features of vasculitis are not strictly pathognomonic but certain morphologic DSA findings are very typical and may allow for a radiologic diagnosis. For instance, atherosclerosis results in irregular contours of vessel walls in DSA in contrast to autoimmune diseases and vasculitis, which are usually characterized by smooth vessel walls and optional vasospasm, the latter being especially typical for thromboangiitis obliterans and scleroderma. In thromboangiitis obliterans occlusions of the distal hand arteries, corkscrew collateral vessels and subsequent development of fine collateral networks are typical findings. Abrupt or filiform occlusions of distal finger arteries with sparse collateralization and symmetric affection of both hands are suggestive of scleroderma. Disseminated segmental ectasis and stenosis as well as microaneurysms (63% of all patients) are very common in patients with panarteriitis nodosa.