CARDIOVASCULAR SURGERY BASICS NOTES List the causes of upper limb ischemia, particularly acute limb ischemia Ischemia of the upper limb is rare. This is because: Atherosclerosis is less common here because: BF here is less turbulent and shear stress compared to the lower limbs. Rich collateral blood supply via scapular anastomosis that can bypass the subclavian artery. Causes: Subclavian artery compressed at the thoracic outlet. For example, in thoracic outlet compression syndrome. Emboli Brachial artery or more distal artery occlusion. The brachial artery is the most common site of lodgement within the upper limb. Trauma Vasospastic disorders. E.g. Raynaud phenomenon -> digital ischemia. Aortic dissection Clinical features: Pain Pallor Pulseless Paraesthesia Perishing coldness Paralysis Recognise when acute limb ischemia of the upper limb is critical and requires urgent investigation and management. Clinical features Sudden onset Severe pain Pallor Pulselessness Coldness Paraesthesia Paralysis Time sensitivity Golden six hours Complete arterial occlusion can lead to irreversible tissue damage within approximately 6 hours. Immediate action Early senior surgical support is vital. List the causes of arteriovenous fistulas, including iatrogenic. Basics: Abnormal connections between an artery and a vein. Congenital abnormalities Penetrating Traumas Gunshots Stab wounds Iatrogenic: Percutaneous procedures Femoral artery cannulation during invasive procedures. Surgical interventions Dialysis related.