Diagnosis and treatment of atraumatic vascular insufficiency of the upper extremity: female smoker's syndrome.

A retrospective analysis of 30 angiograms in 29 patients performed at Doctor's Hospital since June of 1989 was carried out. Of these, 15 patients with 16 involved extremities presented with no antecedent trauma and significant symptoms of arterial insufficiency with impending digital necrosis. Eleven were female and four were male. Underlying medical problems included renal failure in four, diabetes in two, scleroderma in two and vasculitis in one. A unique group of six patients had no prior underlying medical problems. All six patients were female and all were smokers. A surprisingly high incidence of major arterial occlusion was noted. The radiographic features appeared distinct from the common causes of vascular insufficiency in the hand, that is, Raynaud's, thromboangiitis obliterans (Buerger's disease), and ulnar artery thrombosis from repetitive microtrauma (hypothenar hammer syndrome). This review is intended to discuss the evaluation and management of this group of patients.