Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec 9;3(11):e551.
doi: 10.1097/GOX.0000000000000522. eCollection 2015 Nov.

Long-term Patency of Primary Arterial Repair and the Modified Cold Intolerance Symptom Severity Questionnaire

Bernd Lannau  1 , Jacqueline Bliley  1 , Isaac B James  1 , Sheri Wang  1 , Wesley Sivak  1 , Kang Kim  1 , John Fowler  1 , Alexander M Spiess  1
Affiliations

Long-term Patency of Primary Arterial Repair and the Modified Cold Intolerance Symptom Severity Questionnaire

Bernd Lannau et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The goal of this study was to assess the long-term arterial patency of repaired arteries in the upper extremity and any morbidity resulting from the subsequent occlusion of these vessels. Concurrently, a new questionnaire, the modified Cold Intolerance Symptom Severity (mod CISS) questionnaire, was developed to allow for better assessment of cold intolerance.

Methods: Thirteen patients who had undergone repair of the radial (4 patients), ulnar (6 patients), brachial (1 patient), digital (1), and an undefined lower arm artery (1) were examined using questionnaires, physical examination, and high-resolution ultrasound.

Results: Outcome measures that were statistically significantly worse in the group of patients who presented with nerve injuries included cold intolerance symptoms, Disabilities of the Arm, Shoulder, and Hand score, Michigan Hand Questionnaire, and grip strength (middle setting on dynamometer). The results from the mod CISS correlated with high statistical significance with the results of the CISS score for the injured hand. Of note, wrist extension was significantly better with patent arteries.

Conclusions: Sixty-seven percent of arterial repairs remained patent at 6 years (mean) follow-up. The presence of nerve injury has a higher impact on the outcome metrics assessed in this study than arterial patency. Our modification of the CISS score enhances its utility as a survey of cold intolerance.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Figures

Fig. 1.
Fig. 1.
Example of high-resolution ultrasound assessment of vessel patency using color Doppler.
Fig. 2.
Fig. 2.
A, The difference in Cold Intolerance Symptom Severity (CISS) score between the healthy and injured hand based on the presence of initial nerve damage. Note the negative Y axis. B, The difference in modified CISS score between the healthy and injured hand based on the presence of initial nerve damage.
Fig. 3.
Fig. 3.
A, The scatter plot shows the relation between the Cold Intolerance Symptom Severity (CISS) score of the injured hand and the modified CISS (mod CISS) score. B, The scatter plot shows the relationship between the CISS score of the healthy hand and the mod CISS score. C, The scatter plot shows the relationship between the difference in CISS score and the mod CISS score.
Fig. 4.
Fig. 4.
Box-plot showing grip strength on the first setting (A) third setting (B), and fifth setting (C) based on arterial patency. Box-plot showing 2-point discrimination of the thumb (D) and the index (E) on the injured hand based on arterial patency. F, Box-plot showing Michigan Hand Questionnaire score of injured hand.
Fig. 5.
Fig. 5.
Suggested prospective protocol to help clearly answer the initial questions set forth in this study.MHQ, Michigan Hand Questionnaire; CISS, Cold Intolerance Symptom Severity; VAS, visual analogue scale; DASH, Disabilities of the Arm, Shoulder, and Hand.
See this image and copyright information in PMC

References

    1. Borman KR, Snyder WH, 3rd, Weigelt JA. Civilian arterial trauma of the upper extremity. An 11 year experience in 267 patients. Am J Surg. 1984;148:796–799. - PubMed
    1. Aftabuddin M, Islam N, Jafar MA, et al. Management of isolated radial or ulnar arteries at the forearm. J Trauma. 1995;38:149–151. - PubMed
    1. Ballard JL, Bunt TJ, Malone JM. Management of small artery vascular trauma. Am J Surg. 1992;164:316–319. - PubMed
    1. Bacakoğlu A, Ozkan MH, Göktay AY, et al. Forearm arterial vein grafting: problems and alternative solutions. J Int Med Res. 2003;31:458–465. - PubMed
    1. Johnson M, Ford M, Johansen K. Radial or ulnar artery laceration. Repair or ligate? Arch Surg. 1993;128:971–974; discussion 974–975. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8368933. Accessed May 14, 2015. - PubMed