Predicting Upper Extremity Arterial Disease - Analysis of Patient Symptoms and Comorbidities
Kareem Hassan, M.D., Timothy Bruce, M.D., Logan Galansky, Russell Reid, M.D., Ph.D, Ross Milner, M.D., Patrick Reavey, M.D., M.S..
University of Chicago, Chicago, IL, USA.
PURPOSE:Upper extremity arterial disease (UEAD) is increasing in prevalence in our aging population, largely due to continued advances in the care of cardiovascular disease. Despite the increasing prevalence, early symptoms and specific risk factors for UEAD are not well understood, leading to difficultly predicting the presence of UEAD. This may lead to inadequate preoperative identification of patients with UEAD, which may contribute to flap loss, wound healing problems or even iatrogenic critical limb ischemia. The purpose of the study is to further elucidate the risks for UEAD by correlating patient comorbidities, symptoms and demographics with results from upper extremity arterial duplexes. We hypothesize patient symptoms and medical comorbidities will correlate with the presence of UEAD.
METHODS:A retrospective chart review was performed on 264 consecutive patients from 2015-2017 who received upper extremity arterial duplex studies the University of Chicago Medical Center. The medical record was then queried for: patient demographics, the patient's upper extremity symptoms and clinical indication for the study, medical and surgical history. The presence of UEAD was determined by a combination abnormal flow velocities in an arterial duplex or abnormal wrist brachial index (WBI). Patients with incomplete medical records, studies for acute thrombosis, or indications unrelated to arterial disease or patient symptoms were excluded. Statistical analysis was performed with t-test for continuous variables and chi-squared analysis for binary variables. Multi-variable logistic regression was then performed to model and correlate risk factors for UEAD.
RESULTS:149 arterial studies in 115 patients were included in the analysis. 108 (72.5%) studies demonstrated the presence of UEAD. 51% of patients were male and majority (60%) were African American. The average age of patients was 58.7 years. The most common symptom prior to exam was hand or finger pain however, there was no relationship between any of the patient symptoms and the presence of UEAD (Table 1). The presence of diabetes, lower extremity arterial disease, chronic kidney disease and end stage renal disease had significant risk of UEAD (Table 2). Multivariable analysis demonstrated that only kidney disease and lower extremity arterial disease were significant predictors for UEAD when controlling for other variables.
CONCLUSION:Symptoms historically thought to correlate with upper extremity vascular disease, which frequently prompt duplex investigations, demonstrate no statistical correlation with abnormal upper extremity vascular duplex studies. Patients with kidney disease and lower extremity arterial disease are at increased risk for upper extremity arterial disease. Given lack of correlation with symptoms, physicians taking care of at risk patients should consider screening for UEAD in asymptomatic patients. Plastic surgeons should consider screening high risk patients prior to performing reconstructive surgery using the upper extremity, as sacrificing vessels for flap harvest or recipient vessels may further compromise flow leading to critical limb ischemia.
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