Ulnar Artery Research Articles

Pellet Embolus in Ulnar artery - A rare vascular Injury

Intravascular embolization of bullets and other foreign bodies is a rare complication of penetrating trauma. It can represent a diagnostic challenge because it may present in various and unexpected ways. We report the case of a 65-year-old male who sustained shotgun pellet emboli to left ulnar artery following a right and left upper extremity gunshot injury.
 Pulse volumel.11 January-December 2018-2019 p.33-37

Cadaveric study of division of the median nerve by the persistent median artery.

The purpose of this study is to characterize the division of the median nerve by the persistent median artery (PMA) and highlight the associated clinical implications. Penetration of the median nerve by the PMA is believed to cause compression of the median nerve and affect nerve conduction velocity. This paper explored whether the origin and the pattern of PMA dictate its ability to divide the median nerve. Origin, and relationship of the PMA to the median nerve were documented in 60 cadavers donated to the Human Anatomy Program at UT Health San Antonio. Entire path of this artery was followed in the forearm and the hand. Twenty-five cases of a persistent median artery (PMA) were found in the upper limbs (20.83%; 25/120) of these donated cadavers. Most of the persistent median arteries originated from the ulnar artery (48%; 12/25) and the others originated either from the anterior interosseous artery (36%; 9/25) or from the common interosseous artery (16%; 4/25). Sixty percent (15/25) of the persistent median arteries penetrated and divided the median nerve in the forearm. Interestingly, all the persistent median arteries that originated from the ulnar artery (100%; 12/12) divided the median nerve in the forearm and a palmar type of PMA was found to be more likely to divide the median nerve. Clinicians performing surgeries in the forearm and hand need to be aware of this anomaly and should screen patients for the presence of this artery prior to surgical intervention.

61 STROKE MIMIC CASE REPORT: A YOUNG PATIENT WITH COVID-19 REFERRED TO NEUROVASCULAR CLINIC SUBSEQUENTLY DIAGNOSED WITH SYSTEMIC ARTERIAL EMBOLI

Abstract Background An independent 44 year-old is reviewed at Neurovascular Clinic with a suspected high-risk Transient-Ischaemic-Attack (TIA). He had a recent diagnosis of COVID-19. Investigations revealed multiple systemic arterial emboli responsible for his symptoms, rather than a cerebrovascular cause. Methods The patient attended our Neurovascular Clinic following a virtual Stroke Consultant telephone assessment 3 days previously, when he had been referred from his GP with a brief episode of left arm weakness. This was felt to be a high-risk TIA event. He had tested COVID-19 positive with mild flu-like symptoms 4 days prior to this event. He described sudden onset weakness involving the left forearm and wrist which became ‘floppy’. Symptoms had fully resolved within one hour. His only reported vascular risk factor was controlled essential hypertension. He was a life-long non-smoker with no family history of stroke. On examination his left arm felt significantly colder than the right. His radial pulses bilaterally were palpable with good volume. Blood pressure was satisfactory in both arms. No other focal neurology was found. Results Computed-Tomography (CT) angiogram of the left arm revealed an occlusion of the ulnar artery in the antecubital fossa, dilated aortic root, splenic infarcts and probable pulmonary emboli. CT pulmonary angiogram revealed large bilateral volume pulmonary emboli within both main pulmonary arteries extending into all lobar branches of both pulmonary arteries. A Patent Foramen Ovale was not seen on bubble-contrast transthoracic echocardiogram. Diffusion-weighted Magnetic-Resonance-Imaging (MRI) Brain was normal. Anticoagulation with Apixaban for 6 months was commenced for provoked emboli following consultation with our trust haematologist. Conclusion This case of a so-called “stroke mimic” highlights a pitfall of virtual assessment for neurovascular patients and the need for assessing in person those who we should have a higher suspicion for alternative pathology, especially in those who were recently COVID-19 positive given documented pro-thrombotic tendencies.

Reverse Neurocutaneous Flap Based on the Dorsal Branch of the Ulnar Artery for Palm Coverage in Children: Long-Term Results

Although the palm is spared mostly in severe burn injuries, it often is affected in children and requires radical excision of contracting scar tissue to allow normal hand development. Since alternatives are limited for palmar coverage, we primarily use a reverse-perfused, neurocutaneous dorsal ulnar artery flap. We report here our long-term follow-up results. We reviewed the long-term results of 10 postburn palmar contracture release and flap coverage procedures in 10 children. The applied flap was based distally on the dorsal branch of the ulnar artery and harvested along the ulnar aspect of the hand and wrist. The pivot point of the flap was located dorsally, close to the 4th and 5th metacarpal base. Patients were followed for a median period of 6 years (range, 4-20 years). Flap size ranged from 60-130 mm in length and 20-35 mm in width. This variation in flap dimensions resulted from different hand sizes, because of the various patient ages at surgery. All flaps survived, donor site healing was uneventful, and marginal flap necrosis occurred only once. Satisfactory restoration of range of motion without secondary contractures was observed. Moreover, we detected adequate progressive growth, adaptability and sensory recovery in all flaps. Over time, the flaps mostly become hairless and progressively flattened without debulking. The importance of this flap lies in the potential for considerable tissue mobilization to cover palmar defects without sacrificing any major vascular axis. The adequate progressive growth of the flap facilitates functional hand development in children. The predictable vascular anatomy, wide range, and durable, thin, and pliable skin make the reverse neurocutaneous dorsal ulnar artery flap an appealing option for soft tissue reconstruction of the palm in children. Therapeutic V.

Transitioning from Microsurgery to Supermicrosurgery: The Recurrent Ulnar Artery Model.

Transitioning from Microsurgery to Supermicrosurgery: The Recurrent Ulnar Artery Model.

Surgical treatment of infectious ulnar artery aneurysm.

Infectious ulnar artery aneurysm is a rare condition with no standardised treatment. Our patient was treated with a simple proximal ligature without excision of the aneurysm.

THE CLINICAL AND DEVELOPMENTAL SIGNIFICANCE OF ULNAR ARTERY VARIATION DURING SURGERIES AND MEDICAL INTERVENTIONS

Background – Ulnar artery is a branch of brachial artery,it descends supercially and vertically between the FCU and FDS in lower two third of forearm. Then it passes above the exor retinaculum at wrist later forming supercial palmar arch. During routine dissection in S.N Medical College, Agra, an unusual nding was Case Report- identied in both the upper limb of a 60 year old male cadaver. Ulnar artery runs laterally to ulnar nerve and then passes underneath the exor retinaculum. Then it joins with the Supercial Branch of Radial Artery to form Supercial palmar arch. Variation of Ulnar artery is uncommon.It is important in surgical cases of Carpal tunnel release surgery, also can be confused with supercial veins during interventions.

Study of course and termination of brachial artery by dissection and computed tomography angiography methods with clinical importance.

The Brachial artery is a continuation of the axillary artery, from the inferior border of the tendon of teres major to the neck of the radius, terminating into radial and ulnar arteries just a cm distal to the elbow joint. Unlike veins, variations in the arteries are comparatively less common. Anatomical variations of the brachial artery occur in almost 20% of the cases and are commonly found during routine dissection or clinical practice. To observe the variations in the course and termination of brachial artery by dissection and computed tomography (CT) angiography methods. The present study was conducted on 40 upper limbs each in the department of Anatomy & Radiology of JSS Medical College and Hospital, Mysuru. The brachial artery was traced from origin to termination and variations were noted and photographed. Patients who were undergoing CT angiography of the upper limbs in JSS Hospital were included in the study. Variations noted and compared with the dissection method. In the present study, normal patterns of the brachial arterial course and termination were observed in 31 specimens. The remaining 9 specimens showed variant course and termination in the brachial artery like an unusually tortuous superficial brachial artery, superficial brachio-ulnar artery and brachio-radial artery. CT angiography showed 6 variations and a tortuous brachial artery. A detailed description of the vascular pattern of upper limbs especially variations in their origin and termination is of extreme importance in clinical practice. The knowledge of these variations is important for catheterization, graft harvesting, arteriovenous fistula creation, shunt application and astrup examination.

Complications Following Ulnar Artery Catheterization for Coronary Angiography.

Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant complications, including pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve injury, and critical hand ischemia. The purpose of this study was to describe complications specific to ulnar artery catheterization. After obtaining institutional review board approval, a retrospective review was performed on all patients who underwent ulnar artery catheterization at our institution between 2019 and 2021. Complications were assessed, and complication rates were compared with previously published studies on ulnar artery catheterization for coronary angiography (percutaneous coronary intervention). A total of 41 patients were available for review with a mean age of 59 years. Of these, 17 patients (41%) sustained complications in the immediate postprocedural period. These complications included hematoma (12 patients, 29%), pseudoaneurysm (1 patient, 2%), ulnar artery thrombosis (1 patient, 2%), ulnar neuropathy (3 patients, 7%), arterial damage requiring repair (2 patients, 5%), transient ischemia (3 patients, 7%), and compartment syndrome (2 patients, 5%). Three of these patients (7%) required operative intervention, and several were admitted to the hospital for an additional period of observation. This series highlights the significant risks associated with ulnar artery catheterization for percutaneous procedures. Complications include pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve damage, and critical hand ischemia. Several of these patients required urgent or emergent surgical intervention, with some patients experiencing ongoing ulnar nerve symptoms.

Ultrasound Classification of Finger Pulp Blood Flow in Patients With Systemic Sclerosis: A Pilot Study.

To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P=0.024), whereas cold challenge decreased FPBF (P=0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient=-0.50, P=0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31-19.21], P < 0.0001). PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow.

ANATOMICAL VARIATIONS IN ARTERIAL SUPPLY OF THUMB AND INDEX FINGER IN CADAVERIC HANDS

Human hand is highly evolved in terms of complexity and variations. In this modern medical era, vascular anatomy of the human hand has clinical importance in medical, surgical and radiological sciences. The intention of the current study is to determine the variations which occur as the radial artery branches thus making a contribution to the arterial supply of the index finger and the thumb. The study design was descriptive case series, carried out in the Department of Anatomy in King Edward Medical University from December 2018 to May 2019 on 30 cadaveric limbs. Vivisection of the cadaveric hands was performed following Cunningham’s Manual of practical anatomy. The origin and the course of RA, UA and MA were dissected and identified with further exploration of the blood supply of the index finger and the thumb. All details were entered in a predesigned proforma, and the dissected limbs were photographed. Data was analyzed to find the frequencies of superficial palmar arch as well as the arterial supply of thumb and index finger were also expressed in frequencies. Great variation was observed in the arterial supply to palmar aspect of index finger and thumb. Main contributing artery being radial artery in majority of cases through its common palmar or proper palmar branches arising from SPA or SPBRA. Ulnar artery and median artery were also observed to be supplying these areas in 6.6% and 3.3% cases respectively. The median artery when present was replacing the radial artery on palmar aspect of hand. The dorsum, however, was supplied by the princeps pollicis and the radialis indicis branches of radial artery in all the cases. We concluded that in about 1/3rd (11/30 are incomplete SPA) of our studied sample, arterial supply of the index finger and the thumb is highly dependent on radial artery and should any damage occur to it, vitality of these useful structures will be compromised.

Effects of Compression of the Ulnar Artery on the Radial Artery Catheterization.

Background: The study was designed to evaluate the effects of compression of the ulnar artery on blood flow (BF) and internal cross-sectional area (CSAi) of the radial artery. We also evaluated the success rate and time of successful ultrasound-guided radial artery catheterization at the first attempt with or without compression of the ulnar artery. Methods: Patients were randomly allocated to the Compression group or Standard group to be treated with or without the application of ulnar artery compression, respectively. Hemodynamic stability was confirmed, and ultrasound-guided radial artery catheterization was performed. In the Compression group, an assistant compressed the ulnar artery at 5 cm above the wrist crease and the catheterization was performed after the loss of the distal ulnar artery BF. In the Standard group, the catheterization was performed without compression of the ulnar artery. Before and after the catheterization, BF and CSAi of the radial artery were evaluated. Success rate and time to successful catheterization at the first attempt were recorded. Results: BF and CSAi of the radial artery were similar in the two groups (37.5 [19.3–66] vs. 37.0 [20.6–53.7] mL/min, respectively, p = 0.63; 4.0 [4.0–6.0] vs. 4.0 [3.0–5.0] mm2, respectively, p = 0.095). In the Compression group, BF and CSAi were changed to 80.9 [35.9–128.5] mL/min (p < 0.001) and 5.0 [4.0–7.0] mm2 (p < 0.001), respectively, after compression of the ulnar artery. There was a trend that the success rate of ultrasound-guided radial artery catheterization at the first attempt was higher in the Compression group than in the Standard group (58/59 vs. 53/59, respectively, p = 0.05), although the difference was not statistically significant. However, the time to successful ultrasound-guided radial artery catheterization at the first attempt was significantly shorter in the Compression group than in the Standard group (34 [27–41] s vs. 46 [36–60] s, p < 0.001). Conclusion: Compression of the ulnar artery augmented BF and CSAi of the radial artery. It resulted in a significantly shorter success time for ultrasound-guided radial artery catheterization at the first attempt.

Reappraisal of arterial anatomy of thumb.

The nomenclature of arteries supplying the thumb and its sources arteries differs between the studies. This makes difficulty in understanding the irrigation pattern to the thumb. The main purpose of this study was to identify the proper digital arteries supplying the thumb on its radial and ulnar side from both the palmar and dorsal aspect. Also this study aimed to trace its source and classify with proper definition with the review of blood supply to thumb. Dissection was carried out in 55 hands form 28 freshly embalmed adult human cadavers of both genders. The proper digital arteries to the thumb and its source arteries were carefully traced and defined. Thumb receives its dominant blood supply mostly from its palmar side. The ulnar palmar digital artery was seen in all the dissected hand (100.0%) whereas; the radial palmar digital artery was present in 53 hands (96.4%). The radial dorsal digital artery and ulnar dorsal digital artery were observed in only 10.0% and 7.3%. The most common source of both the palmar digital arteries to thumb was from first palmar metacarpal artery (FPMA). In majority of the hands, in addition to the radial or ulnar palmar digital arteries from the FPMA, there were also additional palmar digital arteries arising from the superficial palmar arterial system. The universal naming of the proper digital arteries to the thumb as well as its source arteries is mandatory for the proper understanding of normal as well as variant arterial anatomy of thumb.

EP29.06: Do not overlook the extremities: prenatal detection of fibrosarcoma of the hand

Tumours of the hand can arise from various tissues and may present before birth. These tumours are rare and prenatal detection plays an important role in the understanding of the natural history and pathophysiology, which may be associated with serious illness or even death in the fetal or neonatal period. We present the case of a 29-year-old second gravida who came for an anomaly scan at 23 weeks of gestation. The ultrasound examination revealed a hypoechoic mass lesion along the dorsal aspect of the left hand (figure1) measuring 4.7 × 4.0 cm in size. Power Doppler examination showed moderate central and perilesional vascularity (figure 2a,b). Colour Doppler and 3D power Doppler showed dilated radial and ulnar arteries in the forearm (figure 3 a,b). On spectral Doppler, low impedance flow seen within the mass lesion (figure 4). No other associated anomaly was seen. Fetal magnetic resonance imaging (MRI) of the mass showed a low-signal-intensity soft tissue mass on T1-weighted imaging and inhomogeneous high-signal-intensity on T2-weighted imaging (figure 5a,b). The mass was seen in the subcutaneous plane overlying the wrist and proximal part of the hand and there was no cortical destruction or marrow involvement. During the course of the pregnancy, the mass showed significant increase in the size with associated increase liquor at 28 weeks of gestation. The patient went into preterm labour at 31 weeks of gestation due to polyhydramnios and delivered a male baby who developed neonatal respiratory distress and died. The histopathological examination of the mass provided a diagnosis of fibrosarcoma. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Extra-anatomic temporary intravascular shunting to assist with replantation of an amputated hand with prolonged ischemic time.

Although temporary intravascular shunting has been reported to assist with hand revascularization and replantation after traumatic amputation, most reports have described using ipsilateral upper limb inflow. We present a case of a traumatic hand amputation in a patient who had presented with 4 to 5 hours of warm ischemic time. Because the replantation team believed that extra-anatomic revascularization would be necessary, we performed a novel type of temporary intravascular shunting by connecting two arterial sheaths placed in the ulnar and superficial femoral arteries. This permitted the hand to be successfully replanted away from the inflow source and resulted in a good long-term functional outcome.

Coronary stent-graft use to salvage a juxta-anastomotic arterial rupture complicating a case of radio-cephalic fistuloplasty

BackgroundStenosis is a common complication of haemodialysis arteriovenous accesses. Endovascular approaches with percutaneous transluminal fistuloplasty have largely replaced open surgical approaches as first line treatment. Vessel rupture is an uncommon complication of fistuloplasty and most reports describe venous rupture. Stent-graft deployment can salvage this, however, its use requires careful assessment of the distal vasculature. Arterial rupture with fistuloplasty has rarely been described in the literature. This is a novel case describing the use of a BeGraft coronary stent-graft to manage juxta-anastomotic arterial rupture and pseudoaneurysm complicating fistuloplasty.Case presentationA 77 year old female with end stage renal failure secondary to systemic amyloid light chain type amyloidosis was referred for a suspected radio-cephalic arteriovenous fistula stenosis after difficulty cannulating with poor flow during dialysis and clinical reduction in the fistula thrill. Both Doppler ultrasound and intravenous fistulography confirmed a venous stenosis 2 cm distal to the anastomosis. The stenosis was treated by fistuloplasty, however, this was complicated by a rupture of the juxta-anastomotic arterial segment intraoperatively. Intermittent balloon tamponade was used to minimise extravasation although a pseudoaneurysm formed within the damaged arterial segment. The patient’s distal neurovascular status was assessed using the Barbeau test and we sonographically confirmed adequate retrograde arterial flow via a complete palmar arch directing blood from the ulnar artery. After discussion with the renal transplant team, a 4 mm BeGraft coronary stent-graft was deployed to control haemorrhage and bypass the pseudoaneurysm until adequate haemostasis and fistula flow was achieved. Follow-up 3 months post-procedure reported the patient continued with haemodialysis using the stented fistula with no further complications.ConclusionsTo our knowledge, this is the first case report describing the application of BeGraft coronary stent-grafts to salvage fistuloplasty of a radio-cephalic arteriovenous fistula stenosis complicated by juxta-anastomotic arterial rupture and pseudoaneurysm formation. We demonstrate the safety and short-term efficacy of this technology.

Anatomical variations of the superficial palmar arch in human fetuses.

The superficial palmar arch is an important anatomical structure that contributes to the arterial supply of the palmar side of the hand in the upper extremity. However, there is limited information on the embryological morphological structure of the superficial palmar arch in the literature. We studied the types of the superficial palmar arch and determined their variations by dissecting 80 upper extremities of 40 formalin-fixed human fetuses (19 males, 21 females) 18-37weeks of age. The types and variations of the superficial palmar arch were examined, and the median artery was imaged. The superficial palmar arch type was complete in 58 hands (72.5%) and incomplete in 22 hands (27.5%). The complete group consisted of type A (47.5%), type B (16.25%), type C (3.75%), type D (1.25%), and type E (3.75%). On the other hand, the incomplete group consisted of type F (15%), type G (8.75%), type H (2.5%), and type I (1.25%). A median artery that originated from the ulnar artery and passed through the carpal tunnel during its course was detected in two hands (2.5%). Knowledge of the superficial palmar arch variations will contribute to hand microsurgery particularly in vascular graft and free flap application interventions for arterial bleeding in the palmar region.

A Practical and Effective Method in End-to-End Anastomosis of Radial or Ulnar Artery: Intracath Technique

A Practical and Effective Method in End-to-End Anastomosis of Radial or Ulnar Artery: Intracath Technique

LEVEL OF BIFURCATION OF BRACHIAL ARTERY AND ITS CLINICAL SIGNIFICANCE

Background: Brachial artery is the continuation of the axillary artery and the brachial artery usually divides in the upper limb at the level of the neck of the radius in the cubital fossa. In some specimen, it may be bifurcates into radial and the ulnar artery at a higher level than the normal. The level of division of the brachial artery may vary. Authors also reported the absence of the brachial artery.,in that case the radial and the ulnar artery arose directly from the axillary artery. The present study is aimed to assess the percentage of high bifurcation of the brachial artery into radial and the ulnar artery. The study was carried out in theMaterials and Methods: Department of Anatomy, Sree Mookambika Institute of Medical Sciences. A total of 108 specimens on both sides of the upper limb was observed and traced the brachial artery for its division. In the present study, out of 108 specimens, bifurcation of brachial artery atResults and discussion: the level of neck of radius is about 96.2% and the division of brachial artery at the level of middle third of the arm is 3.12 % and the division at the level of upper third of the arm is 1.08 % was observed. Vessels of the upper limb have much more importance in different kinds ofConclusion: diagnostic, analytic and therapeutic studies. Diagnostically this type of variation may disturb the evaluation of angiography images. Further knowledge of such variation has got clinical importance especially in the eld of orthopaedic, vascular, and plastic surgeries.

Bilateral popliteal artery occlusion in a young woman as a rare complication of systemic sclerosis: A case report

Systemic sclerosis (SSc) is an autoimmune rheumatic disorder characterized by vascular damage, sclerotic skin changes, and multi-system involvement of internal organs. Digital ischemic lesions, nailfold capillary abnormalities, and secondary Raynaud’s phenomenon are common manifestations of microvascular injuries. Recent findings have revealed that macrovascular involvement in SSc more prevalent than previously believed. There have been reports of large vessel involvement, such as the ulnar, femoral, carotid, renal, and pulmonary arteries. We report here a case of a young woman with progressive SSc who complained of lower limb pain, dysphagia secondary to esophageal dysfunction, and urinary incontinence.She had symptoms of Raynaud’s phenomenon, skin sclerosis, sclerodactyly, digital pitting ulcers,nailfoldcapillary abnormalities, and digital ischemia. On special examination, the anti-centromere antibody was detected. She developed bilateral popliteal artery occlusion as a complication of SSc.