Clinical Example: Segmental ulnar artery excision and repair for aneurism with emboli
|
Arterial insufficiency of the fingers may be due to a
variety of problems, including vasospastic problems such
as Raynaud disease, partial or complete local blockage,
or blood clots traveling downstream from the heart or
large arteries. The ulnar artery in the palm is prone to injury because it runs through the heel of the palm, an area which people lean on, push with, and hit (hypothenar hammer syndrome). An injured artery may form an aneurism containing blood clots which can break off, running downstream into the fingers, where they block blood flow and trigger blood vessel spasm. This is an example of such a situation, treated by removing the damaged arterial segment and repairing the ends to restore flow and prevent further emboli. |
| Click on each image for a larger picture |
| This 42 year old
man was evaluated for episodes of cold, painful
fingers over the last two weeks. Examination showed
splinter hemorrhages, which look like splinters in the
nailbed, but are actually the effects of tiny blood
clots, usually breaking off from a larger upstream
blood clot. |
| An arteriogram
demonstrated partial blockage of the ulnar artery in
the palm consistent with a partially occluded ulnar
artery aneurism. |
| It also showed
segmental digital artery occlusion suggestive of tiny
emboli in the middle, ring and small fingers. |
| In preparation for
vascular graft reconstruction, possible forearm donor
veins were marked prior to tourniquet inflation. Veins
branching in a distal direction were chosen in the
event that a "Y" shaped graft was needed. Pisiform,
hamate and ulnar artery course are marked as well as
the surgical incisions. |
| The aneurism with
intraluminal clot is seen as brownish coloration of
the vessel wall. |
| Prior to excision,
the elasticity of the ulnar artery and the possibility
of end to end repair was tested. |
| The artery
appeared sufficiently elastic to allow repair without
graft. |
| Diseased segment
excised. |
| Intraluminal
thrombus. |
| Urokinase was
injected intraarterially into the distal segment to
promote thrombolysis of digital emboli during the
vascular repair. |
| Repair. |
| After touniquet deflation. |
| The patient had an uneventful recovery and no further vasospastic episodes. |
|
Search for... Ulnar Artery Aneurism |
Case Examples Index Page | e-Hand home |