Table 4 Causes of hand ischaemia and indication for CTA or MRA
Causes of hand ischaemia | Underlying aetiology | CTA or MRA |
|---|---|---|
Peripheral emboli | Cardiac disease Thoracic outlet syndrome Atherosclerosis Aneurysm and pseudoaneurysm of proximal arteries of the upper limb | NI Dynamic CTA of the thoracic outlet CTA of the entire upper limb CTA of the entire upper limb |
Iatrogenic | Radial access for monitoring or catheter-based procedures | CTA may be indicated in cases of pseudoaneurysm |
Acute and subacute trauma | Lacerations, fracture, crush injury, etc | CTA |
Occupational | HHS HAVS | CTA or MRA of the hand CTA or MRA of the hand |
Intra-arterial injections of drugs | Voluntary or accidental intra-arterial injection of drugs into an artery in the hand or upper limb | CTA may be indicated in cases of pseudoaneurysm |
Thromboangiitis obliterans | Occlusion of small- and medium-sized arteries | CTA or MRA of the entire upper limb and of the hand |
Autoimmune and rheumatic diseases | Systemic sclerosis Systemic lupus erythematosus Vasculitis (PAN), Sjogren’s syndrome | Usually NI but CTA or MRA may be performed to rule out vasculitis mimics |
Drug/chemical-related | Amphetamines, beta-blockers, bleomycin, cisplatin, cyclosporine, interferon, methysergide, polyvinyl chloride | NI |
Vaso-occlusive disease | Cold agglutinin disease, cryofibrinogenemia, malignancy (including paraneoplastic phenomenon), etc. | NI |
Other causes | Frostbite | NI |