Bilateral radial artery pseudoaneurysms associated with bilateral ulnar artery atresia: a case report

Progressive fingertip necrosis after nail avulsion injury in a patient with ulnar artery hypoplasia: A case report

RATIONALE

Slowly progressive hand ischemia is mostly associated with medical illness such as vasculitis, and in patients with smoking history, Buerger disease is often considered first. However, despite the very low incidence of vascular anatomical anomalies, they can lead to hand ischemia. And if there is no consideration for them, proper treatment cannot be selected.

PATIENT CONCERNS

A 42-year-old male smoker presented with a slowly progressing 5th fingertip necrosis following blunt trauma.

DIAGNOSES

Angiography revealed congenital hypoplasia of ulnar artery, and excluded Buerger disease or hypothenar hammer syndrome.

INTERVENTIONS AND OUTCOMES

We reconstructed the necrotic fingertip using a 2nd toe pulp free flap to reflect the patient's need.

LESSONS

In this case report, the authors emphasize that the possibility of anatomical anomaly should be considered as a cause of the ischemia. Vascular imaging should be undertaken to investigate the cause of ischemia of the hand.

[Pseudoaneurysm of the radial artery in the hand]

Over 1,400,000 cases of hand trauma are identified each year in France, with a large proportion with open wounds, accounting for significant activity in orthopedic surgery emergency units. It is customary to focus on nerve or tendon injuries as a priority. However, even partial vascular lesions may be complicated by a false aneurysm. We report the case of a false aneurysm of the palmar branch of the radial artery in 25-year-old man, 6 months after a non-treated puncture wound of the thenar eminence. Surgery was undertaken because of increased volume and discomfort on gripping. The surgical procedure consisted of resection and arterial ligature, after a positive preoperative Allen test. Hand aneurysms require an individualized therapeutic procedure. Origins may be diverse; the palmar digital location requires complex treatment. Compensation via a collateral arterial network is required for the vascular steal following ligation and resection. Careful exploration is needed to ensure appropriate compensation. Otherwise, a revascularization procedure must be considered. Some authors propose new less invasive treatments as an alternative to surgery. Even though surgery is relatively simple, the best means of prevention still remains a systematic exploration of vascular elements in case of a hand wound.

Bilateral radial artery aneurysms in the anatomical snuff box seen in marfan syndrome patient: case report and literature review

We describe the first Marfan syndrome case of non-traumatic bilateral radial artery aneurysms in the anatomical snuff box. A 74-year-old woman with Marfan syndrome had a pulsatile mass in her bilateral anatomical snuff box. The color Doppler ultrasonography showed an aneurysm of radial artery located in the bilateral anatomical snuff box. Resection of the right radial artery aneurysm was completed without complications. Histopathological analysis showed a true aneurysm with atherosclerotic changes in the arterial wall. We review the literature on non-traumatic or bilateral radial artery aneurysm in the anatomical snuff box, and discuss the clinical presentation and surgical management.

Peripheral nerve lesions associated with missile-induced pseudoaneurysms

Object

Reports of traumatic pseudoaneurysms associated with nerve compression are rare, and typically do not focus on the damaged nerves. This prospective study examines the clinical presentation, management, and treatment outcome of such nerve injuries.

Methods

Between 1991 and 1995, 22 patients with a missile-induced nerve injury associated with a pseudoaneurysm were treated surgically at the Belgrade Military Medical Academy. The artery and nerves involved with the injury were treated using appropriate surgical procedures, and both the sensorimotor deficit and pain intensity were assessed.

Results

The occurrence of a pulsatile mass depended on the location of the pseudoaneurysm (p = 0.003) and correlated significantly with the preoperative diagnosis (p < 0.001). In cases in which neurological worsening was due exclusively to the compressive effect of the pseudoaneurysm, the nerves involved were found to be in anatomical continuity intraoperatively, and recovery depended on the actual nerve damage and surgical procedure required (neurolysis or nerve grafting). A symptomatic nerve compression duration of more than 3.5 days was the critical factor that determined if neurapraxia developed into severe nerve damage (p = 0.014). Pain syndromes responded well and rapidly to the surgical treatment (p < 0.001).

Conclusions

Whether or not a missile-induced pseudoaneurysm associated with a nerve lesion will be recognized before surgery depends on its location and clinical presentation. The nerves involved almost invariably exhibit a lesion in continuity, but the resulting nerve damage can be severe, particularly if surgery is delayed for more than 3 to 4 days after neurological worsening has begun. A successful outcome may be expected if an appropriate surgical technique (neurolysis or grafting) is chosen on the basis of the intraoperative discovery of nerve action potentials.