Vascular Disease

A vascular disease is a problem with arteries and veins, which carry blood to and from the fingers and hand.

Arteries are hose-like structures that bring oxygen-rich blood away from the heart to the fingers. Veins return used blood back to the heart and lungs. At the wrist, the radial and ulnar arteries bring blood into the hand and form arches that branch out to supply blood to each finger and the thumb.

Vascular diseases are problems related to blood flow. They are less common in the upper extremities than in the lower extremities, but they still affect about 10% of people. They can cause pain, open wounds, slow healing of injuries, or even loss of body parts.

Causes

People with certain conditions are more likely to have vascular disorders, including diabetes, high blood pressure, or kidney failure. Working with vibrating tools, cold temperatures, and smoking can worsen vascular problems.

Causes of vascular diseases usually fit into one of five groups:

1. Traumatic, which occur after an injury
2. Compressive, which occur when something squeezes the vessels and the pipes flatten
3. Occlusive, which occur when something blocks the vessels or pipes
4. Tumors or malformations, which are growths or deformed, tangled pipes that may or may not be present at birth
5. 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 in cold temperatures or locations
• Numbness or tingling in the fingertips
• Swelling
• Cool or cold fingers and/or hands

Diagnosing a Vascular Disease

To diagnose a vascular disease, your doctor will perform a physical examination and may find decreased or absent pulses, full veins, masses, wounds, or gangrene at the fingertips.

Diagnostic tests may include x-rays, Doppler or ultrasound examination of blood flow, artery pressure and pulse recordings, arteriography, cold stress testing, or magnetic resonance angiography.

Treatment

Treatment varies depending on the vascular disease. Examples include:

Trauma

Traumatic injuries can partially or completely cut a vessel, such as from a knife wound. A vessel can also be hit or stretched badly enough to damage its lining and cause a blood clot. Poor blood flow after trauma can make the fingers turn white, cold, and painful. If blood flow has stopped, the vessel needs to be repaired with surgery as soon as possible. Sometimes nearby arteries can continue blood flow, and the injury may not be an emergency or may not require repair.

Aneurysms

An aneurysm is a weakness in the artery wall that expands like a balloon. A soft, painless swelling may be noticed over the artery. A clot inside the artery can block blood flow or scatter smaller clots to the fingertips. Other symptoms include pain, numbness, color changes, or gangrene 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 may not be noticed until they begin to expand. 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 or cold hands have finger arteries that narrow more than normal 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 triggers, using protective clothing such as mittens or gloves, taking medications that increase blood flow to the fingers, and sometimes surgery. Surgery may be considered if pain cannot be controlled or wounds do not heal.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.