Presentations

Abstract

Introduction:

Hypothenar hammer syndrome (HHS) is a peripheral vascular disorder of the hand that could lead to digital ischemia because of distal embolic events from the pathological segment of the ulnar artery (UA).1 Formed by the terminal end of the UA and radial artery (RA), the superficial palmar arch (SPA) is the major source of arterial inflow (AI) to the hand.. Anatomical variants of the SPA are described based on the presence (complete) or absence (incomplete) of anastomosis between the RA and UA.

Case Information:

We are presenting two cases of right-hand dominant males age 38-years-old and 53- years-old, who presented with symptomatic hypothenar hammer syndrome, confirmed with computerized tomography arteriogram (CTA) showing decreased AI to the radial side of the hand. Upon exploration, an incomplete SPA variant was seen in one, and a thrombosed UA aneurysm was identified in the other patient. The pathological segments of the UA were resected and revascularization was done with a lateral femoral circumflex arterial graft with instant gain of multiphasic doppler signals at the pulp off all of the digits and resolution of all his pre-operative symptoms.

Discussion/Clinical Findings:

HHS is a rare pathology that can lead to devastating changes in the fingers including irreversible necrosis requiring finger amputation. Arterial reconstruction with a vein graft has been described.2 Our cohort is unique in that an arterial graft was used to repair the ulnar artery. An artery was selected due to neointimal hyperplasia that has been described to affect veins adapted to an arterial environment due to the native veinous wall not being physiologically adapted for high blood pressure, high shear stress, high wall pulsation and stretch of an arterial system.3 Although our cohort has short-term follow-up of less than 1 year, the arterial grafts may provide better long-term outcomes in these young individuals.

Conclusion:

Our patients had successful outcomes of ulnar artery reconstruction with an artery. Further research with long-term follow-up is needed to determine whether arterial grafting of HHS provides superior outcomes to venous grafting.