Vascular Disease
A vascular disease is a problem with arteriesand veins. Arteries are hose-like structures that bring oxygen-rich blood away from the heart to the fingers. Veins are also hose-like structures or pipes that return the used blood back to the heart and lungs. At the wrist, the two main arteries are the radial and ulnar arteries, which bring blood into the hand. These arteries form two arches that branch out to supply blood to each of the fingers and thumb (Figure 1).
Vascular diseases are problems related to the flow of blood. These blood supply or vascular diseases are less common in the upper extremities (arms) than in the lower extremities (legs). They still affect about 10% of people. They can cause problems such as pain, open wounds, slow healing of injuries or even loss of body parts.
Causes
People who have certain conditions are more likely to have vascular disorders. Some of these common conditions include diabetes, high blood pressure, or kidney failure. Other factors such as working with vibrating tools, being in cold temperatures, and smoking can worsen vascular problems.
Causes of vascular diseases usually fit into one of five groups:
- Traumatic, which occur after an injury
- Compressive, which occur when something squeezes the vessels and the pipes flatten
- Occlusive, which occur when something blocks the vessels or pipes
- Tumors (growths) or malformations (deformed, tangled pipes), which may or may not be present at birth
- Vessel spasms, which occur when abnormal control of vessels causes them to narrow
Signs and Symptoms
Symptoms of a vascular disease can include:
- Pain
- Abnormal color changes in the fingertips
- Ulcers or wounds that do not heal
- Hand pain when in cold temperatures or locations
- Numbness or tingling in the fingertips
- Swelling
- Cool or cold fingers and/or hands
Treatment
Diagnosing a vascular disease
To diagnose a vascular disease, your doctor will perform a physical examination and may find:
- Decreased or no pulses at the armpit, elbow, wrist, or fingers
- Full veins
- Masses
- Wounds or gangrene at the fingertips
Diagnostic tests that your doctor may run include:
X-rays of the hand
- Doppler or ultrasound examination of blood flow in the arteries and veins (Figure 2)
- Artery pressure and pulse recordings to measure blood flow in the arm and finger vessels, using small blood pressure cuffs and an ultrasound
- Arteriography, where a special dye is injected into the vessels, and x-rays of the hand and arm are taken. It can show the most vessel detail.
- Cold stress test, where the temperature and blood pressure in the finger(s) are recorded before and after the hand is placed in cold water, sometimes using a local anesthetic to numb the area first
- Magnetic resonance angiography, which is an MRI of the affected area that pays special attention to the vessels (Figure 3)
TREATMENT
Treatment will vary depending on the vascular disease. Here are some examples:
Trauma– Traumatic injuries can cause a vessel to be partially or completely cut, such as from a knife wound. The vessel can be hit or stretched badly enough to damage its lining and cause a blood clot. Poor blood flow after trauma makes the fingers turn white, cold, and painful. The vessel needs to be repaired with surgery as soon as possible if blood flow has stopped. Sometimes nearby arteries can help to continue blood flow to the parts. In this case, the injury may not be an emergency or might not even require repair.
Aneurysms– An aneurysm is a weakness in the artery wall that expands like a balloon (Figure 4). A soft, painless swelling may be noticed over the artery. A clot inside the artery can block the blood flow or may scatter smaller clots out to the fingertips. Other symptoms include pain, numbness, color changes, or gangrene (death) of the fingertips. Treatment may include surgery to reconstruct the artery or tie it off, depending on the circumstances.
Vascular malformations– Tangled veins or arteries can be present at birth, but might not be noticed until they begin to expand. Some of these malformations might include abnormal connections between veins and arteries. Symptoms can include swelling, pain, warmth, increased growth of a part, and bleeding. Treatment choices include garments or wraps to apply pressure, clotting the vessels to try to shrink them, or removing part or all of the abnormal vessels with surgery.
Raynaud’s– Patients with Raynaud’s phenomenon/disease or cold hands have finger arteries that narrow more than normal when they are in cold temperatures. The fingers turn white and painful and then blue. Recovery of blood flow turns the fingers pink or red. Treatment includes avoiding the conditions that causes the reaction, using protective clothing such as mittens or gloves, taking medications that increase blood flow to the fingers, and surgery. Wounds or ulcers on the fingers can heal poorly due to the low blood flow. Surgery to lessen the vessel narrowing or replace blocked parts of vessels can be considered if pain cannot be controlled or wounds do not heal.
© 2020 American Society for Surgery of the Hand
This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.