Focal arterial dilation measures about 11 x 8 mm with arterial wall around it.Ulnar artery shows branching just after this focal dilatation. She had no specific past medical history, but an episode of falling. /MediaBox [0 0 595 794] Ultrasonography revealed arterial blood flow inside. /Type /Pages A resection without reconstruction, Hypothenar hammer syndrome: posttraumatic digital ischemia, True aneurysms of traumatic origin in the palm. The doctor performed a diagnostic puncture, which resulted in fresh blood flowing out of the tumor. His parents both had hypertension. An ulnar artery aneurysm was suspected. S Roshan Rodney, Vivek Anand, M Vishnu, Sumanth Raj, Hemant Chaudhari, C P S Sravan, Vaibhav Lende, Hudgi Vishal, K Siva Krishna, B Nishan Only a few reports have been done. (B) A vessel loop was put beneath the ulnar artery proximal to the mass. /Pages 5 0 R Continuity of the arterial network from the radial artery to the fingers was confirmed. There is fusiform dilatation of ulnar artery in the hypothenar region at the site of pain. %PDF-1.4 Conn J Jr., Bergan JJ, Bell JL. << At this moment, the tourniquet was released. << In our case of occupational true aneurysm of the ulnar artery, preoperative angiography revealed poor collateral formation palmar arch (Fig. In this patient, the aneurysm occurred at this common site (Fig. (B) MR angiogram showed that the ulnar artery flow was reduced and deviated at the mass (white arrow). Zig zag incision at the hypothenar area to prevent contracture since straight incision frequently causes postoperative contracture, and use of bipolar electrocautery to prevent nerve damage seemed to be beneficial. (A) A subcutaneous mass was seen. /S /D We, therefore stretched the artery and had sufficient length to make a direct anastomosis of the ulnar artery. /doi (10.1016/j.crvasa.2016.11.008) When we pressed the radial artery and ulnar artery simultaneously, the mass became smaller. >> If not, interposition vein graft is usually used, considering the morbidity of harvesting arteries. The 3). >> 10.1016/j.crvasa.2016.11.008 and transmitted securely. /Type /Page endobj Mass on wrist; Treatment of ulnar artery aneurysm; Ulnar artery aneurysm Vessel loops were applied around the arterial branches to control. /BleedBox [0 0 595.26 793.68] Histologically, it was diagnosed as a true aneurysm (Fig. We recommended protection of hypothenar area with leather gloves, and prohibited the use of vibration tool. Occupational true aneurysms of the ulnar artery in the palm have reportedly resulted from hypothenar hammer syndrome, which is an uncommon vascular overuse syndrome.1) An ulnar artery aneurysm is caused by trauma of the palmar portion of the ulnar artery, usually as a result of occupational or sport activities that involve repetitive microtrauma on the heel of the hand.1,2) Surgery is the gold standard treatment for a large aneurysm, that is at high risk of rupture or distal embolization.1,3) The aneurysm technically could be resected and vascular reconstruction could be performed by a direct anastomosis of the distal and proximal ulnar artery, or a simple ligation and bypass procedure using a saphenous vein graft.1,4). >> uuid:05fea216-a368-4cc1-b287-ee7c66749da1 Surgical therapy for hypothenar syndrome has included excision of the ulnar artery aneurysm with ligation of the ulnar artery or reconstruction of the ulnar artery by direct anastomosis or by interposition vein grafting.1,8). Susumu Isoda and all other authors have no conflicts of interest to report. Management of true aneurysms distal to the axillary artery. /Kids [12 0 R] 2021; 81: 105821, Indian Journal of Vascular and Endovascular Surgery | Published by Wolters Kluwer -. Postoperative course of the patient was uneventful. << /Parent 5 0 R Sekino S, Takagi H, Kato T, Matsuno Y, Sekido Y, Umemoto T. Nguyen DQ, Murison M. Ulnar artery aneurysm in a patient with Marfan's syndrome. /Contents [13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R] Blood flow to the fingers and pulsation of the severed artery branches were reconfirmed. Major symptoms are pain around the hypothenar eminence and paraesthesia of fingers as compression effect on the ulnar nerve, and cold intolerance as ischaemia effect with thrombosis.
/Resources 21 0 R Department of Plastic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. 8600 Rockville Pike National Library of Medicine Copyright (c) 2017 The author(s). /Subtype /XML {"url":"/signup-modal-props.json?lang=us\u0026email="}, Patel, M. Ulnar artery aneurysm. Adherence of the mass to the ulnar nerve (yellow arrow) was observed. The Author(s) 2021. https://www.indjvascsurg.org/text.asp?2020/7/2/187/286918, International Journal of Surgery Case Reports. We thereafter made a zigzag skin incision, which extended from the wrist to the distal part of the aneurysm, to prevent postoperative hypothenar contracture. << https://doi.org/10.1016/j.crvasa.2016.11.008 There was a mass of approximately 2 cm in the right small thenar, and the mass was pulsatile. The trauma, involving repetitive striking to the hypothenar eminence, during occupational or sports activities, is called to be the cause. /TrimBox [0 0 595.26 793.68] Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan. /BleedBox [0 0 595.26 793.68] Surgery 1970;68:1122-8.
4087 oiJ=ymS/p;I'?%[% Reconstruction of the vascular deficit was not performed. The adventitia had severe fibrosis, mucoid degeneration, and granulation formation (Fig. 1A). Injury to tunica media results in wall weakening and aneurysm development. /ArtBox [0 32.281 595.26 793.68] He complained of numbness in the region of the ulnar nerve. The proximal ulnar artery adjacent to the aneurysm was sclerotic with a corkscrew deformity that was 15 mm in length and was unsuitable for anastomosis. Both deep and superficial branches of the ulnar nerve were identified. Pineda CJ, Weisman MH, Bookstein JJ, et al. We resected the pulsating mass compressing the ulnar nerve, utilizing a surgical microscope. Upper extremity aneurysms. /Names 3 0 R
He underwent aneurysm resection with ligation of the ulnar artery. There have been reports of congenital case operated at 1-year-old [1] and idiopathic one of 6-month-old [2]. >> Mazzaccaro D, Malacrida G, Stegher S, Occhiuto MT, Caldana M, Tealdi DG. 2). Ann Vasc Surg 2018;46:367.e15-9. His blood pressure was 160/90 mmHg (untreated). Endress RD, Johnson CH, Bishop AT, Shin AY. /Producer (Acrobat Distiller 10.1.16 \(Windows\)) Learn more
Long-term complications from the replacement of the artery with vein graft were also discussed.
True
Especially for young patients, placing vein at this part with high internal pressure is not recommended, unless there is no other option.
(B) Lining of the lumen with endothelial cells was confirmed. A dull rise with thrill was observed on the hypothenar eminence. Other etiologies reported in the literature were vasculitis, anatomic abnormalities, or infections. /Kids [10 0 R 11 0 R] An X-ray of the right hand showed no abnormalities. /PageLabels 4 0 R /Length 7 0 R SolenSoftware Actavia 3.4 (Journal system)
7 0 obj /Rotate 0 Computed tomography (CT) showed that the right ulnar artery contained a saccular aneurysm (22 mm 30 mm) (Fig. /ArtBox [0 32.281 595.26 793.68] Presurgical images. Kisacik B, Kasifoglu T, Akay S, Yilmaz O, Yilmaz S, Simsek I. Makarenko TP, Klimkovich IG. /Nums [0 9 0 R] Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. Bacourt F, Bornet P, Fourcade R, Davous N, Lacombe P. Aneurysm of the ulnar artery in, Clagett PG. Before (A) A computed tomography (CT) scan shows a saccular aneurysm (22 mm 30 mm) of the right ulnar artery. This work is licensed to the public under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license. Journal
Acrobat Distiller 10.1.16 (Windows)
No bone fracture was observed. >> You can use Radiopaedia cases in a variety of ways to help you learn and teach. /CropBox [0 0 595 794] 11 0 obj Mazzaccaro D, Malacrida G, Stegher S, et al. The ulnar artery is vulnerable to trauma since it has little protection above it and only bony protection below it.
Copyright 2022 Oxford University Press and JSCR Publishing Ltd. De Santis F, Martini G, Mani G, Zywica M, Zipponi D. Forearm and hand arteries' aneurysms A case report of bilateral true ulnar artery aneurysm in the hypothenar eminence and systematic review of the literature. 2 0 obj Under general anaesthesia, air tourniquet was applied. Laboratory data showed no abnormalities, other than an increase in the level of brain natriuretic peptide to 48.6 pg/ml. Ulnar artery aneurysm >> The mass appeared just beneath the skin. /Keywords (Mass on wrist; Treatment of ulnar artery aneurysm; Ulnar artery aneurysm) /MediaBox [0 0 595 794] Presented with several days of right hypothenar pain and paresthesia. >> Mass on wrist The new PMC design is here! Cerit Levent
Before that, parents did not realize any abnormality of her hand. << We intravenously administered heparin (3000U) and applied a tourniquet for avascularization to prevent bleeding. Sensory or motor disturbances were not noted postoperatively. Occupational ulnar artery aneurysm can be successfully treated by resection and direct reanastomosis. ADVERTISEMENT: Supporters see fewer/no ads. Surgical findings. 2A). 13 0 obj We taped the ulnar nerve by using a nerve stimulator, and placed tape around the ulnar artery at the proximal and distal parts of the aneurysm (Fig. /Limits [ ] He was asymptomatic for distal embolization. uuid:450a8d07-2af3-49d0-a16f-f91e360a8427 3 0 obj endobj about navigating our updated article layout. endobj A 32-year-old male patient was admitted to the hospital with a pulsing mass of the right palm. The patient was right-handed. << Department of Plastic Surgery, Hyogo College of Medicine. Pathological examination revealed intimal degeneration with thrombus formation and medial degeneration with the disappearance of smooth muscle and elastic fibers. Ulnar artery aneurysms are rare and fewer than 150 patients have been reported in the medical literature.1) An ulnar artery aneurysm is frequently comorbid with digital ischemia, which we did not experience in our patient. A 32-year-old-male patient visited the orthopedic clinic complaining of a pulsatile tumor with pain for one month in the right palm. Endothelial cells of vasa vasorum were also stained (CD31 stain, 20x objective lens). As hypothenar eminence is a susceptible part for repetitive strikes, and as vein is fragile to the pressure, bypassing arterial route with vein graft is not recommended unless there is no other option. sharing sensitive information, make sure youre on a federal Jain Institute of Vascular Sciences, A Unit of Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India, Correspondence Address:Dr. S Roshan RodneyJain Institute of Vascular Sciences, A Unit of Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka IndiaSource of Support: None, Conflict of Interest: NoneCheckDOI:10.4103/ijves.ijves_95_18 function RightsLinkPopUp () { var url = "https://s100.copyright.com/AppDispatchServlet"; var location = url + "?publisherName=" + encodeURI ('Medknow') + "&publication=" + encodeURI ('IJVS') + "&title=" + encodeURI ('Idiopathic proximal ulnar artery aneurysm') + "&publicationDate=" + encodeURI ('Apr 1 2020 12:00AM') + "&author=" + encodeURI ('Rodney S R, Anand V, Vishnu M, Raj S, Chaudhari H, Sravan C P, Lende V, Vishal H, Krishna K S, Nishan B') + "&contentID=" + encodeURI ('IndianJVascEndovascSurg_2020_7_2_187_286918') + "&orderBeanReset=true" e496 He was an electrical construction engineer who frequently used a screwdriver. The https:// ensures that you are connecting to the Copyright (c) 2017 The author(s). The dilated true aneurysm was compatible with a traumatic origin.
The youngest traumatic case, found in our literature search, was a case of 6-month-old baby with a 2-months history of swelling [3]. endobj 4 0 obj We resected the aneurysm and reconstructed the ulnar artery. (A) We taped the ulnar nerve (white arrows) by using a nerve stimulator and placed tape around the ulnar artery at the proximal and distal parts of the aneurysm (black arrows). Tel: +81-798-45-6753; Fax: Congenital aneurysm of the ulnar artery in the palm, Ulnar artery aneurysm in a 6-month-old: a case report, Rare presentation of an ulnar artery aneurysm in a six-month-old baby: case discussion, Diagnosis and excision of an ulnar artery aneurysm in a two-year-old boy, Hypothenar hammer syndrome: surgical approach in patients presenting with ulnar artery aneurysm, Serial angiographic follow-up beyond 10 years after coronary artery bypass grafting, Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials, Surgical management of hypothenar and thenar hammer syndromes: a retrospective study of 31 instances in 28 patients, Hypothenar hammer syndrome: long-term results of vascular reconstruction, Recurrent ulnar artery aneurysm of the palm after venous grafting: a case report. endobj A case in Pakistan, where preoperative evaluation of the palmar arterial arches was not possible, Y-shaped cephalic vein was used [3]. The ulnar artery lies superficial in the palm where it is at risk of compression due to the hook of the hamate.
1). Pathological examination shows intimal degeneration with thrombus formation and medial degeneration with the disappearance of smooth muscle and elastic fibers. << endobj
/Subject (, doi: 10.1016/j.crvasa.2016.11.008) Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC, et al. Proximal part of the artery to the mass was ligated and severed. L&'1>/OZ?#4%:D%|MeX1#PiZ$q~R4v=XW~seXr,qt[:46lkiMdNyv4'=jXh[ PMC legacy view https://creativecommons.org/licenses/by-nc-nd/4.0/ JXa^-8 k(~ E O W\O@]+H # :/(sxGA#_ /CropBox [0 0 595 794] Case study, Radiopaedia.org. 1). Histopathology of the aneurysmal wall showed true aneurysm of the ulnar artery. For ulnar artery reconstruction, patency rates of venous interposition grafts are not high (5 out of 14 in 43months [8], 4 out of 18 in 118months [9]) As there is no tunica-media, veins are vulnerable to the pressure. >> The .gov means its official. He was an electrical construction engineer who frequently used a screwdriver.
Reconstruction of the deficit was discussed. stream (A) The aneurysm was sliced. >> Ulnar artery aneurysm is very rare in infancy. /Names [ 24 0 R] will also be available for a limited time. Meals CG, Carey GB, Higgins JP, Chang B. Arima M, Kanoh T, Suzuki T, Kuremoto K, Tanimoto K, Oigawa T, et al. 2017-10-24T13:10:54+02:00 (accessed on 22 Jul 2022) https://doi.org/10.53347/rID-54746. The proximal ulnar artery was long and meandered. 9 0 obj /Type /Catalog 5 0 obj Hypothenar eminence is a susceptible part for repetitive strikes. /Rotate 0 /ModDate (D:20171024131054+02'00') An 8-month-old infant was referred our department for a mass on her right hand. The doctor referred the patient to the cardiovascular surgery department. endobj HW[WHO5-pbAE{n /Filter /FlateDecode Veins will dilatate after arterialvenous shunting for haemodialysis. Khirurgiia (Mosk) 1958;34:109-11. Ulnar artery aneurysms are very rare, usually caused by repetitive blunt trauma to the ulnar artery, leading to the formation of an aneurysm. Acute encephalopathy with biphasic seizures and late restricted diffusion temporally associated with human bocavirus infection. Hypothenar hammer syndrome: Posttraumatic digital ischemia. /Author Infantile cases are quite rare. Idiopathic proximal ulnar artery aneurysm Postoperative CT angiography revealed good patency of the anastomosis of the ulnar artery and preservation of the superficial and deep palmar arch (Fig. Meticulous dissection through the fascia was carried out and ulnar nerve was identified. :)H'n=;|0xkcbKozd'?^qAfemIRyq\z?e1pLq5+m>b[OLO{O7l|KF5kz&L.M_ 1,UXRXvR(a5Dn9Eqt.I7|\\7w[|{7}yanpo~op The aneurysm was resected without vascular reconstruction. Histologically, it was diagnosed as a true aneurysm. An occupational true aneurysm of the ulnar artery could be treated by resection and direct anastomosis. 59 -0Pjtp2h |(D$JKj9:po, Ulnar artery aneurysm - A rare cause of mass on wrist. application/pdf Oxford University Press is a department of the University of Oxford. /Title (Ulnar artery aneurysm - A rare cause of mass on wrist) We believed that restoring blood perfusion would be a better treatment than a simple ligation and that this treatment would be suitable for him professionally, since he used a screwdriver frequently as an electrical construction engineer. In our presenting case, there was only one episode of falling, without bone fracture. Acquired ulnar artery aneurysm is not a common condition, even though they are famous as hypothenar hammer syndrome. Ulnar artery aneurysm - A rare cause of mass on wrist She did not present any other disorder. 12 0 obj Ann Vasc Surg 2017;44:421.e1-4. As preoperative planning, reconstruction of the arterial deficit was not done. Check for errors and try again. Injury to tunica intima results in thrombosis. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. EIN$:CuXI-2m_|rqb1Dj2y8sujc7Y8k5 I$Wl!5.9;evCj~"_]:Ko7PBHgR4' 6}P5k_e5O/@T`3_n.-?Tx z";Wrt (u /Count 2 e496-e498 3). McHugh SM, Moloney MA, Greco E, Wheatcroft M. True ulnar artery aneurysm in the proximal forearm: Case report and literature review. Vayssairat M, Debure C, Cormier JM, et al. 6 0 obj /Type /Metadata (C) Soon after the resection of the mass. On examination, fingers were normal color. 2017-10-24T13:10:54+02:00 An official website of the United States government. /St 94 Blood flow to the fingers was estimated to be maintained even after the mass extirpation.
There exists a report of a patient in 30s, with recurrent ulnar artery aneurysm after venous grafting [10]. /Contents 22 0 R 00108650
(B) A direct anastomosis of the proximal and distal ulnar artery is performed (arrow). Gray RJ, Stone WM, Fowl RJ, Cherry KJ, Bower TC. SolenSoftware Actavia 3.4 (Journal system) e498 << We used bipolar electrocautery and never used unipolar electrocautery to prevent nerve damage, dissected the abductor muscle of the little finger, and approached the aneurysm of the ulnar artery. >> /EmbeddedFiles 8 0 R , doi: 10.1016/j.crvasa.2016.11.008
Treatment of ulnar artery aneurysm /Creator (SolenSoftware Actavia 3.4 \(Journal system\)) >> 10 0 obj /Parent 5 0 R Keywords:Aneurysms, embolization, ligation, vasculitis. PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. Arterial branches distal to the mass were ligated and cut. The aneurysm was opened, and the thickness of its wall was 3 mm. https://creativecommons.org/licenses/by-nc-nd/4.0/ Strong fibrosis of the adventitia was present in our patient. The anastomosis was performed with a running 70 polypropylene suture (Prolene, Ethicon, Tokyo, Japan) (Fig. OGHmmm=6sxxGY>jy=y4W|}|Xo_o0J3wj=Sti4pUphZVtIW>OSU.T8xA m[?x%+PeA'o&33 2019-03-18T13:26:58+01:00 J Vasc Surg 1998;28:606-10. endobj Tenderness and neuro-radiating pain was not evident, highly possibly because of her age. /TrimBox [0 0 595.26 793.68] Cor et Vasa /Length 10895 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, Indirect ballistic injury to the liver resulting in retained bullet complicated with hepatic abscess: a case report, Combining a small urinary catheter with an endo mini-retractor: a novel technique for laparoscopic selective vascular control, Jejunojejunal intussusception in an adult due to adenoma: a case report, Acute abdomen in a known case of sigmoid cancer and review of Laplace Law: a case report, Looking in a mirror, laparoscopic gastric sleeve in situs inversus patient: a case report, Volume 2022, Issue 7, July 2022 (In Progress), http://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic, An unusual case of hypothenar hammer syndrome in the non-dominant hand, Reconstruction for rupture of profunda femoris artery aneurysm in a patient with sarcopenia, Giant internal carotid aneurysm: endovascular parent artery occlusion after failed treatment using a flow divertercase report, External jugular vein aneurysm presenting as submandibular neck mass.