ATHEROSCLEROSIS, the most common cause of the ischemic lower extremity, rarely involves the arteries in the arms sufficiently to produce symptoms of claudication or threaten loss of limb. Subclavian artery occlusive disease is frequently suspected clinically by a recorded blood pressure difference in the arms. It is occasionally documented by arteriography during investigation of cerebrovascular insufficiency; arm claudication alone, however, is rarely a significant complaint.1 The extensive collateral circulation present around the shoulder is usually adequate to prevent ischemic symptoms.
Occlusion of the axillary and brachial arteries is rare, but may produce ischemic symptoms and threaten loss of fingers.2 Claudication of the arm usually develops resulting in impaired function of the hand. Reports of successful revascularization of the upper extremity following acute trauma are numerous,3-5 but only occasional interest in elective revascularization operations is evident.6 Cervicodorsal sympathectomy is the most common operation performed for upper-extremity ischemia.