Subclavian, vertebral, and upper extremity vascular disease

Upper extremity vascular disease can be conceptually divided into “large-artery” disease involving the inflow arteries, such as the subclavian and axillary arteries, involving the arteries distal to the wrist. Use of drugs causing vasospasm, such as ergotamine, cocaine, and amphetamines, can cause intense upper extremity arterial vasospasm. Takayasu’s arteritis (TA) and giant cell arteritis (GCA) are granulomatous arteritides that can involve the aorta and its major branches. Thoracic outlet syndrome (TOS) refers to the extrinsic compression of the subclavian artery, subclavian vein, and/or brachial plexus, as these course through the scalene triangle, formed by the first rib, the clavicle, the scalenus medius muscle, and the costoclavicular ligament. Although overall uncommon, radiation-induced arterial injury is a well-documented complication in patients with a history of previous head and neck or mediastinal radiation. CT angiography (CTA) and magnetic resonance angiography (MRA) have become among the most valuable non-invasive imaging modalities for the assessment of upper extremity vascular diseases.