Vascular Insufficiency/Chronic Ischemia in the Upper Extremity-Case-Vascular Insufficiency

Case-Vascular Insufficiency

Pdf Summary

The patient in this case is a 35-year-old male auto mechanic who has been experiencing pain and a cool sensation in his ring and small fingers for the past six months. He denies tobacco use but reports using his hand with forceful hammering motions at work. An Allen's test demonstrates perfusion of the hand through only the radial artery, indicating occlusion of the ulnar artery. Additional studies, such as radiographs and noninvasive vascular studies, are conducted and show normal results with a digital brachial index (DBI) of 0.05. <br /><br />The recommended treatment for this patient is surgical intervention. The proposed procedure involves the reconstruction of the ulnar artery by resecting the thrombosed segment and using a reversed saphenous vein graft. <br /><br />Hypothenar hammer syndrome or ulnar artery thrombosis occurs as a result of repetitive trauma to the ulnar artery at the wrist. The occlusion of the ulnar artery can be diagnosed through clinical examination, with an Allen's test being a commonly used method. Advanced imaging techniques like an arteriogram or magnetic resonance angiography (MRA) can also be used for a more accurate diagnosis. <br /><br />The noninvasive vascular studies, specifically the digital brachial index (DBI), can aid in determining the appropriate treatment approach. A DBI value of less than 0.07 suggests inadequate collateral circulation and indicates the need for reconstruction. On the other hand, a DBI value greater than 0.07 indicates sufficient circulation, and ligation of the thrombosed segment can be performed to eliminate distal emboli and associated vasospasm. <br /><br />Surgical treatment typically involves resecting the thrombosed segment and either ligating or reconstructing the ulnar artery, depending on the DBI. Graft options for reconstruction include expendable arteries (such as the lateral femoral circumflex, thoracodorsal, or inferior epigastric) or veins (like the cephalic, basilic, or saphenous).

Keywords

ulnar artery

Allen's test

occlusion

thrombosis

surgical intervention

reconstruction

saphenous vein graft

Hypothenar hammer syndrome

repetitive trauma

noninvasive vascular studies