POST TRAUMATIC VASOSPASTIC DISORDERS OF THE HAND -COMMENTS ON ANGIOGRAPHY AND INTERVENTION

Abstract

The angiographic manifestations of vasospastic disorders in the hand in patients who have sustained various forms of trauma to the hand and arm has not been adequately described in the literature. The findings in our series are evaluated and correlated with the clinical presentation. It is hoped that this evaluation may shed light on the poorly understood relationship between trauma and subsequent development of a vasospastic disorder. Intraarterial Reserpine was administered to determine its effectiveness in this condition mimicking Raynard's phenomena. Each patient was given 15–25 mg. of Priscoline intraarterially prior to injection of contrast material in the distal brachial artery to the involved hand. Magnification views of the hand and routine views of the forearm were obtained according to the area of involvement. Patients developing vasospastic disorders after sustaining trauma demonstrate arterial occlusions in various sites with interruption of one or both carpal arterial arches. Some patients may have had preexisting anatomic variants prior to the trauma. Intraarterial administration of Reserpine has been beneficial in some but not all patients. There does appear to be some correlation with the angiographic findings in patinets with post-traumatic vasospastic disorders and in patients having more classical Raynard's phenomena. No patients had an intact vascular supply with both carpal arches patent. The effectiveness of intraarterial Reserpine in such patients also correlates with this association with Raynard's phenomena. The pattern of arterial occlusions appears to be the most pertinent arterial finding to explain the clinical presentation. Intraarterial Reserpine is suggested as an aid in vasospastic disorders of the hand.