title: Incidence and predisposing factors of cold intolerance after arterial repair in upper extremity injuries.
abstract: OBJECTIVE
  The purpose of this report was to present abnormal posttraumatic cold intolerance in patients that previously underwent repair of arterial injuries after civilian upper limb trauma in our institution.
  
  
  METHODS
  All patients who underwent repair of arterial lesions after upper limb trauma since 1990 were reviewed, and clinical follow-up studies were performed. Patients were asked to complete the cold intolerance symptom severity (CISS) questionnaire to evaluate presence and severity of self-reported cold sensitivity, and the disabilities of arm, shoulder, and hand (DASH) questionnaire to analyze functional disability. Abnormal cold intolerance was defined as a CISS score over 30. Further analysis included evaluation of epidemiologic, clinical, and perioperative data for factors predisposing to abnormal cold intolerance.
  
  
  RESULTS
  A total of 87 patients with previous repair of upper limb arterial injuries were eligible to answer the CISS and DASH questionnaires, and 56 patients (64%; 43 men; median age: 31.9 years) completed both. In our cohort, blunt trauma was the predominant cause of injury (n = 50; 89%). Accompanying lesions of nerves (n = 22; 39%) and/or orthopedic injuries (n = 36; 64%) were present in 48 patients (86%). After a median follow-up period of 5.5 years (range, 0.5-19.7), 23 patients (41% of 56) reported on abnormal cold intolerance. Patients with cold intolerance had worse functional results (as measured by the DASH questionnaire; mean ± SD, 42.7 ± 29.7 vs 11.5 ± 23.9; P < .001) when compared with patients without. Cold intolerance was more frequently seen in patients with previous nerve lesion (P = .027) and in proximal injuries (subclavian or axillary vs brachial or forearm arteries: P = .006), but was not correlated to gender, age, involvement of the dominant or nondominant arm, and the presence of ischemia, bone injury, or an isolated vascular injury.
  
  
  CONCLUSIONS
  Abnormal cold intolerance is frequently seen in patients with a history of arterial repair in upper limb trauma. It is associated with significant functional impairment. Concomitant nerve injury and involvement of the subclavian or axillary artery are the major predisposing factors for development of cold intolerance after upper limb trauma.
authors.affiliation: Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria. josef.klocker@i-med.ac.at
authors.forename: Josef
authors.initials: J
authors.lastname: Klocker
authors.forename: Tobias
authors.initials: T
authors.lastname: Peter
authors.forename: Lukas
authors.initials: L
authors.lastname: Pellegrini
authors.forename: Monika
authors.initials: M
authors.lastname: Mattesich
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Loescher
authors.forename: Michael
authors.initials: M
authors.lastname: Sieb
authors.forename: Peter
authors.initials: P
authors.lastname: Klein-Weigel
authors.forename: Gustav
authors.initials: G
authors.lastname: Fraedrich
mesh_terms: D000328:Adult; D001158:Arteries / Q000293:injuries*; D001366:Axillary Artery / Q000293:injuries; D001916:Brachial Artery / Q000293:injuries; D003080:Cold Temperature / Q000009:adverse effects*; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D013348:Subclavian Artery / Q000293:injuries; D011795:Surveys and Questionnaires; D013697:Thermosensing / Q000502:physiology*; D034941:Upper Extremity / Q000098:blood supply* / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000503:physiopathology*; D014950:Wounds, Penetrating / Q000503:physiopathology; D055815:Young Adult