背景:与下肢缺血相比,上肢急性缺血很少见。这种情况的起源是多种多样的。
目的:我们回顾性分析了2008年至2013年间皮肤科急性手指缺血(排除雷诺现象)的病例,以评估这种现象的病因和治疗方法。
结果:报告13例手指缺血。平均年龄为54岁。11例吸烟活跃。急性缺血9例,亚急性缺血4例。在10例中,该位置是单方面的,在2例中是双边的。病因是:掌弓发育不良,抗磷脂抗体综合征,冻伤,远端动脉炎与吸烟有关,副肿瘤性动脉炎,Buerger病,结节性多动脉炎,锁骨下动脉狭窄,和3例栓塞起源(尺骨,心脏,和副肿瘤动脉瘤)。在急性期,6例给予抗血小板治疗,抗凝剂10例,依洛美定6例。交感神经切断术1例,截肢2例。
结论:本研究说明了手指缺血病因的多样性。病因学测试应广泛,包括免疫学和血栓形成倾向测试,动脉和心脏检查,宫颈X线摄影和CT扫描(癌症筛查)。皮肤科医生之间的密切合作,血液学家,血管外科医师和放射科医师对这些患者的治疗至关重要.
BACKGROUND: Acute ischemia of the upper limbs is rare in comparison with ischemia of the lower limbs. The origins of this condition are varied.
OBJECTIVE: We retrospectively analyzed cases of acute finger ischemia (Raynaud\'s phenomena was excluded) in a dermatology department between 2008 and 2013 in order to evaluate the etiology and management of this phenomenon.
RESULTS: Thirteen cases of finger ischemia were reported. The mean age was 54 years. Active smoking was noted in 11 cases. Ischemia was acute in 9 cases and subacute in 4 cases. The location was unilateral in 10 cases and bilateral in 2. Etiologies were: dysplasia of the palmar arch, antiphospholipid antibody syndrome, frostbite, distal arteritis linked to smoking, paraneoplastic arteritis, Buerger\'s disease, polyarteritis nodosa, stenosis of the subclavian artery, and 3 cases of embolic origin (ulnar, cardiac, and paraneoplastic aneurysm). In the acute phase, antiplatelets were given in 6 cases, anticoagulants in 10 cases and ilomedin in 6 cases. Sympathectomy was performed in 1 case and amputation in 2 cases.
CONCLUSIONS: This
study illustrates the diversity of etiologies of finger ischemia. The etiological test battery should be broad and include immunological and thrombophilia tests, arterial and cardiac investigations, cervical radiography and CT scan (screening for cancer). Close collaboration between dermatologists, hematologists, vascular surgeons and radiologists is essential for the management of these patients.