Post-Traumatic Ulnar Artery Thrombosis: Outcome of Arterial Reconstruction Using Reverse Interpositional Vein Grafting at 2 Years Minimum Follow-Up

Abstract

Conclusion: Successful arterial reconstruction of patients with symptomatic post-traumatic ulnar artery thrombosis (UAT) improves function in microvascular physiology, decreases symptoms, and positively affects quality of life. Summary: The authors report follow-up of use of interposition vein grafts to treat symptomatic patients with UAT. Patients included in this retrospective study had to have arteriographically proven UAT treated with excision and reversed interposition veins grafts, no known collagen vascular disease, coagulopathy, or peripheral vascular disease, and a minimum follow-up of 24 months. There were 13 patients (13 hands) identified and evaluated before surgery and at final follow-up using health-related quality of life outcome instruments. These included the McCabe cold sensitivity scale, the McGill visual analog pain scale, the Levine symptom and function scale, and the Wake Forest University symptoms scale incorporating pain, numbness, and cold intolerance. Microvascular perfusion testing was done using laser Doppler perfusion imaging. Cold stress tests were also performed. Results of cold testing were compared with 28 healthy controls. Graft patency was assessed by Allen testing or Doppler ultrasound imaging, or both. At the final follow-up, 10 of 13 grafts (77%) were patent. In patients with patent grafts, the Levine symptom scale, the McGill visual analog pain scale, and the McCabe cold sensitivity severity score all uniformly improved postoperatively. Cold testing responses also improved at final follow-up and were not different from those of normal controls. Changes in Levine function scale, Wake Forest University scale, and laser Doppler perfusion were not significant. In the three patients with nonpatent grafts, two complained of pain, numbness, and cold sensitivity, whereas the other had minimal symptoms. Comments: Although the number of patients is small, this is actually a relatively large series with prolonged follow-up of an unusual condition infrequently treated by operation. Of particular interest is improvement in quality of life noted in these patients and the normalization of their physiologic response to cold testing. Interposition vein grafting of the distal ulnar artery is relatively straightforward if the thrombosed segment does not involve the digital vessels. In such cases the saphenous vein at the ankle is an appropriate conduit. The operation, of course, is considerably more technically demanding when digital arteries must be reimplanted into the saphenous vein graft. This may be done through individual anastomoses of the digital arteries to the saphenous vein graft, or more commonly in our experience, incorporation as a patch graft of the portion of the thrombosed ulnar artery from which the digital arteries originate onto a longitudinally oriented venotomy in the saphenous vein graft.