Surgical management of ulnar artery aneurysms

Rothkopf, Douglas M.; Bryan, David J.; Cuadros, C. Luis; May, James W.

doi:10.1016/0363-5023(90)90010-o

Cited by 56 publications

(54 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rare causes of true aneurysms of the hand include atherosclerosis, tumours, arteritis and osteogenesis imperfecta. 3 A false aneurysm is usually caused by penetrating injury of the arterial wall. This can be traumatic or iatrogenic (such as complication of arterial catheterisation), leading to the formation of an extra-arterial haematoma that becomes organised with a fibrous capsule.…”

Section: Discussionmentioning

confidence: 99%

Delayed ulnar nerve palsy secondary to ulnar artery pseudoaneurysm distal to Guyon’s canal following penetrating trauma to the hand

Dobson

Purushothaman

Michla

et al. 2013

annals

View full text Add to dashboard Cite

Compression of the ulnar nerve in Guyon's canal is an uncommon phenomenon. Reports of ulnar nerve palsy secondary to ulnar artery pseudoaneurysm at this anatomical location are very rare and equivalent pathology just distal to this site is unheard of.Here we present such a case, which featured a delayed onset of symptoms. This followed penetrating trauma to the hand. Our methods for diagnosis, operative planning and surgical treatment are included.Compression of the ulnar nerve in Guyon's canal is an uncommon phenomenon, described as early as 1908 by Hunt. 1Reports of ulnar nerve palsy secondary to ulnar artery pseudoaneurysm at this anatomical location are very rare. Case historyA 33-year-old man presented to our clinic 3 weeks after a penetrating glass laceration to the hypothenar eminence of his non-dominant right hand. He had attended casualty at the time of his injury while on holiday abroad where the wound was treated with adhesive strips. He reported that there were no functional problems with the hand at the time of the injury but motor and sensory symptoms developed progressively over the subsequent weeks.At the time of our assessment, ulnar clawing of the hand was apparent; the ring and little metacarpophalangeal joints were held in hyperextension with flexion at the interphalangeal joints of the corresponding fingers. Clinically, a sensory deficit was apparent (light touch, 2 point discrimination) in a well demarcated medial one and a half digit ulnar distribution. There was weakness of the interosseous muscles, abductor digiti minimi and lumbricals to the ring and little fingers (Medical Research Council score 3/5). Froment's sign was positive. A pulsatile mass was palpable over the hypothenar eminence. A clinical diagnosis of pseudoaneurysm of the ulnar artery causing neurapraxia of the ulnar nerve was made. The patient underwent ultrasonography and magnetic resonance angiography provided further clarity, demonstrating a pseudoaneurysm measuring 24mm of the ulnar artery as it coursed into the palm, immediately prior to its continuation as the superficial palmar arch (Fig 1).There was no evidence of ulnar nerve transection. Maximal ulnar nerve compression was at a site just distal and

show abstract

Section: Discussionmentioning

confidence: 99%

Delayed ulnar nerve palsy secondary to ulnar artery pseudoaneurysm distal to Guyon’s canal following penetrating trauma to the hand

Dobson

Purushothaman

Michla

et al. 2013

annals

View full text Add to dashboard Cite

show abstract

“…Among these methods to preserve hand perfusion, reconstruction without severing the ulnar artery and addition of a tubular polytetrafluoroethylene or Dacron envelope has been reported, but such an envelope could prove to be problematic with patient growth (6). Reverse saphenous vein interposition graft (9), ipsilateral dorsal hand vein interposition graft (10) and end-to-end anastomosis of the severed artery have also been reported (3,11).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and excision of an ulnar artery aneurysm in a two-year-old boy

2010

View full text Add to dashboard Cite

U lnar artery aneurysms are exceedingly rare in children younger than 10 years of age, with fewer than 10 cases reported worldwide. Secondary to their rarity, the etiology of these lesions is not yet understood. Ulnar artery aneurysms have been characterized in the adult population, usually occurring secondary to occupationally acquired, repetitive stress disorders such as hypothenar hammer syndrome (1-3). The present case report describes the course of treatment for an ulnar aneurysm in the wrist of a two-year-old boy, along with a brief review of the existing literature detailing other approaches to management. CASE prESEntAtionA two-year-old boy presented with a bump on the left arm, which was noticed by the mother during a trip to the emergency room for suspected trauma to the wrist. The mass was originally believed to be a ganglion cyst. It was not known whether the mass had changed in size between the time of discovery and the time of visit to the office. Apart from the visit to the emergency room, the patient's medical history involved a case of omphalitis at 21 days and a frenectomy for tongue-tie at 1.5 months of age, with no history of arterial line placement. The patient's family history of similar lesions was negative.Ultrasound characterized the mass as an ovoid lesion, with the possibility of being a large pseudoaneurysm of the ulnar artery.On physical examination in the office, the mass on the left wrist appeared to be a ganglion cyst. Neither bruit nor thrill were noted, and neurovascularity was normal. No finger ischemia was noted.Magnetic resonance angiography identified the mass on the volar aspect of the left wrist to be a large pseudoaneurysm of the distal ulnar artery just anterior to the wrist. The dimensions were approximately 1.8 cm in length by 1.0 cm in width by 1.2 cm in height. Heterogeneous signal intensities with hyperdense elements on T1 were suggestive of thrombus. No arteriovenous malformations were noted. Magnetic resonance imaging suggested a true aneurysm with thrombosis. The lesion was not determined to occlude the ulnar artery, and an angiographic arteriogram was to be performed to determine both the characteristics of the lesion and whether repair of the ulnar artery was necessary after excision of the aneurysm. Consultation with a geneticist was also elected to investigate possible clinically important congenital or connective tissue disorders such as Kawasaki, Marfan's or Ehlers-Danlos syndromes because they have been implicated in the development of ulnar artery aneurysms (4,5). Based on meeting with the geneticist, the patient was determined to have no connective tissue disorders.Intraoperative arteriogram, 16 days after the magnetic resonance imaging/magnetic resonance angiography, noted that the ulnar artery was completely occluded (Figure 1). No contrast entered the lesion itself and no emboli were noted. A long gap between the end of contrast and the level of the wrist was case report ©2010 Pulsus Group Inc. All rights reserved i Amjad, t Murphy, E Zahn. Diagnosis ...

show abstract

“…Von Kuster et al (1980) propose simple resection, while Martin and Manktelow (1982) and Rothkopf et al (1990) added a vascular reconstruction. More recently, treatment by compression, possibly guided by echography, has been favored for femoral aneurysms (Altkin et al 1989, Agrawal et al 1992, Feld et al 1992, Mac Glinckey and Baxter 1997.…”

Section: Discussionmentioning

confidence: 99%