Deep Palmar Branch Research Articles

Anatomical variations in 3D imaging: A case report of a dorsal metacarpal artery anomaly

This report presents a novel anatomical variant of the second dorsal metacarpal artery (SDMA). In this unique case, the SDMA abnormally penetrates the second dorsal interosseous muscle (SDIM), dividing into two major branches. A deep dorsal branch of the SDMA (dbSDMA) is located within the SDIM and extends to the distal end of the metacarpal. The other branch forms a perforating branch called the P-SDMA, which anastomoses with the palmar metacarpal artery branch (PMAb) and the deep palmar arch branch (DPAcb) in the deep palmar area. The discovery of this SDMA variant is significant for procedures involving complex hand surgeries such as DMA flaps. Understanding this anatomical variation is crucial for accurate surgical planning and can help avoid potential complications during surgery. To elucidate these unique variations, we employ three-dimensional (3D) imaging techniques, demonstrating the potential of these technologies to advance the visualization of anatomical structures and enhance medical education. 3D imaging also facilitates augmented reality applications and 3D printing. Our findings underscore the possible applications of 3D imaging in medical practice and education, potentially transforming anatomy education and surgical planning.

Formation and branching patterns of deep palmar arch

Objective: The present study is to document and provide information about both normal and variable morphology of the deep palmar
 arch (DPA) in adult human cadavers by the dissection method.
 Materials and Methods: We examined 12 upper extremities (6 cadavers). After the classification of the vascular patterns of DPA and
 its branches, measurements of the vessel diameters were carried out using a digital compass.
 Results: Deep palmar arch was found as a completed arch (100%) in all cases. The anastomosis between the distal deep palmar branch
 of the ulnar artery (DPBUA) and the terminal branch of the radial artery (RA) was the most common type in our study. The incidence
 of the DPA was reported as a complete arch ranging from 54.9% to 100%. Palmar metacarpal arteries (MPAs) originating from the
 DPA were divided into four branches (25%) in three cases and three branches (75%) in nine cases. The mean diameter of the MPAs at
 the point of origin at the DPA was between 0.3 mm and 0.6 mm.
 Conclusion: A comprehensive understanding of the DPA branching diameters in the hand will facilitate surgical and radiological
 approaches and contribute to a constantly expanding knowledge base in literature.

Distal radial access for endovascular interventions

This article, based on the guidelines of the European Society of Cardiology (ESC), Russian clinical recommendations and large randomized trials, summarizes information about traditional radial access used in X-ray endovascular interventions. We present a description and characteristics of a new distal radial approach. It is a puncture of the deep palmar branch of the radial artery (DLV LA) and catheterization of the radial artery distal to its bifurcation to the superfi cial and deep palmar arches.The aim of this study is to present real time data about distal radial access as current clinical guidelines do not contain information about this new method; to evaluate its advantages and disadvantages, and to assess the frequency of complications. Analysis of references showed that the new distal radial approach is safe, eff ective, competitive and it may be the method of choice for endovascular interventions.

Proximal bifurcation of the superficial palmar branch of the radial artery and anomalous superficial course of the distal radial artery: a case report

Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.

Variations in the Pattern of the Deep Palmar Arch of the Hand and Its Surgical Importance.

BackgroundThe deep palmar arch is formed by anastomosis of the continuation of the radial artery with the deep palmar branch of the ulnar artery. With recent advances in microsurgical techniques for vascular repair, the knowledge of variations in the arteries of the hand, as well as the caliber of these arteries, has become more important for surgeons. Additionally, radial artery harvesting for myocardial revascularization is being performed nowadays, for which collateral circulation in the hand through the palmar arches is a prerequisite. Therefore, this study was conducted to study the patterns of the deep palmar arch and perform the morphometry of the arch.MethodologyIn this study, 30 hands (16 right and 14 left) from formalin-fixed adult human cadavers were dissected to observe the completeness, formation, and branching pattern of the deep palmar arch. The length of the arch was measured using a thread and scale. The diameters of the forming arteries and branches of the arch were measured at their origin using a digital vernier caliper.ResultsAll deep palmar arches were complete. The arches were classified into two types based on whether the superior or inferior deep palmar branch of the ulnar artery completed the arch. Another classification was based on the interosseous space through which the radial artery or its branch entered the palmar region to complete the deep palmar arch. The length of the arch was 4.2 ± 0.47 cm on the right side and 4.0 ± 0.6 cm on the left side. The diameters of the deep palmar branch of the radial and ulnar arteries at their origin were 4.02 ± 0.48 mm and 1.90 ± 0.36 mm, respectively. No significant difference was found between the right and left sides.ConclusionsThe anastomosis was found between radial and ulnar arteries in all cases of the deep palmar arch. Therefore, it can be safe to sacrifice the radial artery in procedures such as radial artery harvesting and radial artery flap transfer. The knowledge of variations and morphometry of the arch will facilitate vascular repair surgeries on hands.

A Vascular Variation in Radial Forearm Free Flap Harvesting: Distal Branching of the Radial Artery—A Case Report

Study Design: Case report. Objective: By reporting such a rare vascular variation of the radial artery, we aim to make other surgeons aware of comparable vascular variations in radial forearm free flap harvesting. Methods: In this case report, we present an 84-year-old male patient, with a rare distal branching of the radial artery into the deep palmar branch, approximately 7 cm from the wrist. In order to visualize the vascular variation, intraoperative photo documentation took place. Results: The radial free flap harvesting was successful and no postoperative complications were noted. Conclusions: Distal branching of the radial artery into the deep palmar branch may occur in radial forearm free flap harvesting. Since no restrictions in flap perfusion and/or hand perfusion were observed in our case, we recommend radial forearm free flap raising in the traditional way. No changes concerning the design and the positioning of the skin paddle need to be made.

Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique

To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique. Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. There were significant differences in the longitudinal and transverse diameters between pisiform and lunate ( t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness ( t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side ( P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides ( P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch ( P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch ( P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch ( P>0.05). But the differences between the other vascular pedicles were significant ( P<0.05). There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck's disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.

Palmar Arch: Anatomical And Surgical Correlation in Trauma

The irrigation of the palm is provided by arterial arches (shallow and deep) that are made more frequently by the ulnar or radial arteries described as setting a classic pattern. Anatomical variations are described in shaping both arches, most often in the superficial palmar arch; may be the same complete or incomplete. The objective of this work is the anatomical description of the palmar arches, their different patterns and variations in conformation, and their clinical and surgical implications. A descriptive, observational and morphometric study of the arteries involved in the formation of the palmar arches was done in the Faculty of Medicine, University of Buenos Aires. One hundred1(00) cadaveric preparations fixed in formalin solution, of the Third Chair of Anatomy were used. A retrospective analysis of cases with lesions / s artery / main / s that make the palmar arches in the Emergency Hospital of Moron, between 2015-2016 s was also carried out. Most frequently the radial artery forms the deep palmar arch with the deep palmar branch of the ulnar artery. Superficial palmar arch is the most variable. It was complete in 56 % and the most common presentation (83 %) is one that is formed by the anastomosis of the ulnar artery and the superficial palmar branch of the radial artery. The rest of the anastomosis are between ulnar artery and median artery (9%), between deep branch of radial artery and ulnar artery (5 %); triple anastomosis between ulnar artery, median artery and superficial palmar branch of the radial artery (2 %), and anastomosis between the median artery and superficial palmar branch of the radial artery without participation of the ulnar artery (1 %). The rest of the sample (44 %) can be termed as incomplete. The B1a and B1b subtypes were the most found. Two cases, one entire section of the radial artery at the wrist and the other with complete section of ulnar artery with involvement of the ulnar nerve are described. It is essential to a proper understanding of the palmar arches for a suitable surgical approach to hand. The importance of the presence or absence, as well as different variations of palmar arterial arch lies in its clinical application as surgical starting point in the treatment of trauma and other diseases in which there is engagement of arteries.

An anatomical investigation of the superficial and deep palmar arches.

The superficial palmar arch (SPA) and deep palmar arch (DPA) provide the dominant vascular supply to the hand. The SPA is considered to be highly variable and can be classified as either complete or incomplete. The simplest definition states that the anastomosis between the vessels contributing to the arch represent a complete arch, while an incomplete arch is described as characterised by an absence of anastomosis between the vessels contributing to it. This study aimed to describe the anatomical landmarks, formation and branching patterns of the SPA and DPA. In this study, the SPA and DPA were dissected in 50 specimens (n = 100 adult hands), respectively. A complete SPA was observed in 92% of specimens and classified into three types. In Type A (44%), the SPA was formed by the anastomosis of the superficial palmar branch of the radial artery with the ulnar artery. Type B (46%) was formed by the ulnar artery alone and Type C (2%) was formed by anastomosis of the ulnar artery with the superficial palmar branch of the radial artery and the persistent median artery. An incomplete SPA was observed in 8% of the specimens and divided into three types formed by the radial and ulnar arteries. The DPA was divided into five types viz. Type G (72%), where the DPA was formed by anastomosis of the deep palmar branch of the radial artery (DPBRA) with the deep palmar branch of the ulnar artery (DPBUA). Type H (12%), was formed by anastomosis of the DPBRA, the DBUA and the interosseous artery. Type I (8%), was formed by the anastomosis of the DPBRA with the superior and inferior DPBUA. Type J (4%), the deep ulnar artery had two branches whereby either one branch anastomosed with the DPBRA to form the DPA. Type K (4%), the DBUA exhibited two deep branches with one branch anastomosing with the DPBRA to complete the DPA. The interosseous artery anastomosed with either the DPA or the additional DPBUA. Knowledge of the variability of the SPA and DPA is crucial for safe and successful hand surgeries.

A High Bifurcation of the Dorsal Branch with Dominant Superficial Palmar Branch of the Radial Artery: A Case Report of an Aberrant Radial Artery with Traumatic Aneurysm

Anatomical abnormalities such as unusual bifurcations or aberrant arteries of the radial artery are extremely rare and due to malformation or disruption of the vascular net. We present a case of a 64year old woman with a high bifurcated dorsal branch of the left radial artery, consulting us for a pulsatile mass in the anatomical snuffbox after a fall. The mass measured 3-4mm in diameter and was located on the dorsal aspect of the wrist over the anatomical snuffbox. Primary imaging studies using Duplex Ultrasound suggested an aneurysm of the radial artery, further imaging with arteriogram revealed a high bifurcation of the dorsal branch of the radial artery, presenting with an aneurysm. The deep palmar branch of the ulnar artery was the dominating vessel, allowing ligation and excision of the aneurysm. Histological evaluation revealed intimal wall hyperplasia within the aneurysm, suggesting an injury as initiating factor. A review of the literature showed that this abnormality of high bifurcation of the dorsal palmar branch of the radial artery has not been previously reported. Management of aneurysms at the wrist is discussed.

Defining the local nerve blocks for feline distal thoracic limb surgery: a cadaveric study.

ObjectivesThough controversial, onychectomy remains a commonly performed distal thoracic limb surgical procedure in cats. Peripheral nerve block techniques have been proposed in cats undergoing onychectomy but evidence of efficacy is lacking. Preliminary tests of the described technique using cadavers resulted in incomplete staining of nerves. The aim of this study was to develop nerve block methods based on cadaveric dissections and test these methods with cadaveric dye injections.MethodsTen pairs of feline thoracic limbs (n = 20) were dissected and superficial branches of the radial nerve (RSbr nn.), median nerve (M n.), dorsal branch of ulnar nerve (UDbr n.), superficial branch of palmar branch of ulnar nerve (UPbrS n.) and deep branch of palmar branch of ulnar nerve (UPbrDp n.) were identified. Based on these dissections, a four-point block was developed and tested using dye injections in another six pairs of feline thoracic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.07 ml/kg methylene blue was injected at the site of the RSbr nn., 0.04 ml/kg at the injection site of the UDbr n., 0.08 ml/kg at the injection site of the M n. and UPbrS n., and 0.01 ml/kg at the injection site of the UPbrDp n. The length and circumference of each nerve that was stained was measured.ResultsPositive staining of all nerves was observed in 12/12 limbs. The lengths stained for RSbr nn., M n., UDbr n., UPbrS n. and UPbrDp n. were 34.9 ± 5.3, 26.4 ± 4.8, 29.2 ± 4.0, 39.1 ± 4.3 and 17.5 ± 3.3 mm, respectively. The nerve circumferences stained were 93.8 ± 15.5, 95.8 ± 9.7, 100 ± 0.0, 100 ± 0.0 and 93.8 ± 15.5%, respectively.Conclusions and relevanceThis described four-point injection method may be an effective perioperative analgesia technique for feline distal thoracic limb procedures.

An eccentric anatomical variation of palmar vascular pattern: Report of surgical challenging vascular variation

The knowledge of variations in the vascular architecture of hand is of great importance to surgeons, orthopedicians, and plastic surgeons in microsurgical procedures following crush injuries of the hand and amputations. The efficiency of collateral circulation in hand is essential in few peripheral vascular diseases like Raynaud's disease and harvesting of the radial artery for the coronary bypass graft. During routine dissection of the right upper limb of a 55-year-old male cadaver, we observed that the superficial palmar arch (SPA) is formed by the ulnar artery and completed by the first dorsal metacarpal artery. After completing the arch, dorsal metacarpal artery continued as princeps pollicis artery for the thumb. The common palmar digital artery supplying the contiguous side of index and middle fingers passed through the neural loop formed by the proper digital nerve supplying the radial side of the middle finger and joined with the unusually large first palmar metacarpal artery before dividing into proper digital arteries. The first palmar metacarpal artery also gave origin to radialis indicis artery which in turn ran deep to tendons of the index finger to reach index finger. The common palmar digital artery supplying the contiguous side of middle and ring fingers also passed through the neural loop formed by the proper digital nerve supplying the ulnar side of the middle finger. The deep palmar branch of ulnar artery gave proper digital artery to little finger.

Pattern of variations in superficial palmar arch in 134 Negro cadaveric hands.

To investigate the incidence of anatomical variations of superficial palmar arch in Negro population. A total of 134 upper limbs comprising 74 right and 60 left specimens embalmed with formaldehyde were used for the investigation. The hand was dissected with palmar aponeurosis identified and removed to expose the ulnar and radial arteries. A complete superficial arch was observed in 73.9% specimens. In 70.1% cases the superficial branch of the ulnar artery communicated with its radial arterial counterpart. In 3.0% cases the arch was formed entirely by the ulnar artery while in a single case (0.8%), a rare pattern was observed in which the superficial palmar branch of the ulnar artery gave rise to the princeps pollicis artery as its terminal branch with the exclusion of radialis indicis that had its origin from deep palmar branch of radial artery. The incomplete arch constituted 26.1% of the entire palmar arch formation. In our Negro population study, deviation from normal anatomical pattern was common. Therefore, a review of vascular pattern prior to invasive or intervention surgery is strongly recommended to be able to detect anomalies likely to necessitate modification of surgical procedures.

A case of acute deep palmar ulnar neuropathy due to a ganglion after weightlifting diagnosed with short segmental study and diagnostic ultrasound

Ulnar neuropathy in the region of the wrist (UNW) is a rare conition that is sometimes confused with ulnar neuropathy at the lbow and thus can be a challenging diagnosis for physicians [1]. NW can be caused by various etiologies [1]. Recently, occupaional trauma was reported to be the most common cause of deep almar branch lesion of the ulnar nerve [2]. There are several classications of UNW, which was most recently classified into five types ccording to clinico-anatomical lesion location [3]. Electrodiagnosic tests have been developed to differentiate UNW from proximal lnar neuropathy, medial cord or lower trunk lesions of the brachial lexus, and C8 and T1 radiculopathy, as well as to localize UNW nto subtypes according to lesion location. In this case report, we escribe a patient with a deep palmar branch lesion of the ulnar erve in the palm, associated with a ganglion and precipitated by eightlifting. This case report demonstrates the usefulness of short egmental nerve conduction studies of the ulnar nerve around the rist for localizing the lesion [4] as well as the utility of diagnostic ltrasound for detecting a space-occupying lesion.

Vascularization of the hypotenar’s skin as the basis for raising the fasciocutaneous flap

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; The hypothenar&amp;amp;rsquo;s skin is nourished by perforant cutaneous branches which pass across muscle, fascia and palmar aponeurosis. The aim of this work was determination of anatomic characteristics of vascular cutaneous territory of hypotenars as the basis for raising the flaps for the purpose of reconstruction of the defects on the hand. &amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; Micro morphological and morphometric researches have been done on 30 hands of cadavers of both sexes without pathological changes on the blood vessels of the hand. We selectively injected 10% dissolved douche gelatin in two colors into blood vessels of 10 hands . By injecting metyl-metacrylate into the arterial system of 20 hands and by corrosion in 40% solution KOH, we got plastic castings of the arterial network that we have used as the basis for all measures and space analyses in our research. &amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; The trunk of the ulnar artery gives 3-6 cutaneous branches, average 4.1+/- 1.07, and their diameter was about 0.40 to 0.85 mm. Ulnar palmar digital artery of the little finger gives 5 to 9 cutaneous branches, average 7.6. Their diameter was from 0.35 to 0.70 mm. Superficial branch of deep palmar branch of the ulnar artery gives sprigs that vascularize the hypotenar&amp;amp;rsquo;s skin, and they reach the skin through abductor digiti minimi muscle and flexor digiti minimi brevis muscle. That one gives from 2 to5 perforators for the skin of approximately half of the hypotenars, on average 3.70. Their diameter was from 0.25 to 0.70 mm. Cutaneous branches of the superficial palmar arch were reaching either through palmar aponeurosis or by its ulnar border in order to vascularize the radial border of the hypotenar eminence. &amp;lt;strong&amp;gt;Conclusion.&amp;lt;/strong&amp;gt; Hypotenar&amp;amp;rsquo;s skin is nourished by perforant cutaneous of ulnar artery trunk branches, ulnar palmar digital artery of the little finger, deep palmar branch of the ulnar artery and superficial palmar arch. Cutaneous branches of these arteries establish anasthomosises at all levels.&amp;lt;/p&amp;gt;

Lesion of the deep palmar branch of the ulnar nerve: Causes and clinical outcome

We aim to describe the clinical and neurophysiological characteristics of a group of patients with a clinical diagnosis of deep palmar branch lesion of the ulnar nerve. We report the clinical and neurophysiological outcome. Eleven patients (six males, mean age: 52 years) were included prospectively. Neurophysiological studies were performed in all patients at diagnosis and longitudinally in five. Occupational trauma was the cause of the nerve lesion in seven patients, neuritis was diagnosed in one and an idiopathic lesion was the final diagnosis in two. In 10 patients, conservative management with interruption of repetitive trauma led to a progressive full recovery. Hand weakness was progressive in one patient who underwent surgical intervention with a diagnosis of ganglion compression, whose removal caused gradual improvement. Neurophysiological studies confirmed severe deep branch lesion, but in four a mild proximal lesion of the ulnar nerve at the wrist was identified. Follow-up neurophysiological studies confirmed the rapid resolution of the lesion. Conservative management should be the first option in patients with deep palmar branch lesion of the ulnar nerve, in particular in patients with a work-related lesion. Electromyography has a central role in diagnosis.

Percutaneous Angioplasty of the Radial Artery and Its Deep Palmar Branch for Critical Hand Ischemia – A Case Report

Although balloon angioplasty (BA) has been extensively reported to treat peripheral artery occlusive disease, only little information is available about its use for critical hand ischemia. We report a case of a patient with painful ulcerated ischemic lesions of the right hand digits successfully treated by BA of the radial artery (RA) and its deep palmar branch (DPB). The 6-month angiographic follow-up showed a focal restenosis that was approached by a second BA session. Larger series are encouraged to determine the clinical outcome of percutaneous approach in this arterial district. Percutaneous Angioplasty of the Radial Artery and its Deep Palmar Branch for Critical Hand Ischemia – A Case ReportEJVES ExtraVol. 17Issue 5PreviewAlthough balloon angioplasty (BA) has been extensively reported to treat peripheral artery occlusive disease, only little information is available about its use for critical hand ischemia. We report a case of a patient with painful ulcerated ischemic lesions of the right hand digits successfully treated by BA of the radial artery (RA) and its deep palmar branch (DPB). The 6-month angiographic follow-up showed a focal restenosis that was approached by a second BA session. Larger series are encouraged to determine the clinical outcome of percutaneous approach in this arterial district. Full-Text PDF Open Access

Percutaneous Angioplasty of the Radial Artery and its Deep Palmar Branch for Critical Hand Ischemia – A Case Report

Although balloon angioplasty (BA) has been extensively reported to treat peripheral artery occlusive disease, only little information is available about its use for critical hand ischemia. We report a case of a patient with painful ulcerated ischemic lesions of the right hand digits successfully treated by BA of the radial artery (RA) and its deep palmar branch (DPB). The 6-month angiographic follow-up showed a focal restenosis that was approached by a second BA session. Larger series are encouraged to determine the clinical outcome of percutaneous approach in this arterial district.

Persistent median artery in the hand: A report with a brief review of the literature

We encountered a persistent median artery in the forearms and hands bilaterally in a 78-year-old Japanese male cadaver during dissection practice at Wakayama Medical University. The brachial arteries divided into the ulnar and radial arteries. The ulnar artery gave off the median and posterior interosseous arteries at the same point, although the anterior interosseous artery was not found. The median artery ran along the median nerve and bifurcated in the hand. In the superficial layer of the palm, one branch of the median artery ran to the ulnar side of the thumb, whereas the other passed to the second interdigital space. The ulnar artery reached the third and fourth interdigital spaces and the ulnar side of the little finger, and showed no anastomosis with the median artery in the superficial layer of the palm. The radial artery did not give off the superficial palmar branch. Therefore, the formation of the superficial palmar arch was incomplete. In the deep layer of the palm, the radial artery formed the deep palmar arch with the deep palmar branch of the ulnar artery and gave off the princeps pollicis artery. In the dorsum of hand, the radial artery passed over the first dorsal interosseous muscle to the index finger and communicated with the palmar pollical artery from the median artery in the first interosseous space. The present study reports an unusual variation of the persistent median artery in the hand and briefly reviews the literature about the median artery.