Download PDF
Handchir Mikrochir Plast Chir 2018; 50(01): 48-50
DOI: 10.1055/s-0044-101708
Der interessante Fall
© Georg Thieme Verlag KG Stuttgart · New York

Multiple aneurysme in the distal part of the A. ulnaris in a 8 years old boy

Multiple Aneurymen im distalen Abschnitt der A. ulnaris bei einem 8jährigen Jungen
Ireneusz Walaszek
,
Elzbieta Gawrych
,
Justyna Rajewska-Majchrzak
Further Information

Publication History

Publication Date:
28 March 2018 (online)

Also available at
    Permissions and Reprints

Introduction

The aneurysm of the hand is an extremely rare condition, especially in children. A variety of variables, including vessel wall anatomy and potential causative factors, should be considered when clinically differentiating between a true and a false aneurysm (pseudoaneurysm). Majority of hand pseudoaneurysms occur in adults, usually as a result of penetrating trauma or blunt injury, the so-called “hypothenar hummer syndrome”. A hematoma, which initially forms around the damaged vessel wall, is eventually replaced by a fibrous tissue leading to the formation of a false aneurysm. By contrast, a true aneurysm involves the dilatation of all three layers of the vessel wall (intima, media and adventitia), and is most often caused by either blunt trauma or repetitive microtrauma. The anatomical location of the ulnar artery, which in its distal portion (Guyton’s canal) runs subcutaneously in the ulnopalmar region of the hand, makes this vessel particularly susceptible to trauma and thus aneurysmal formation [1]. When an aneurysm of the distal portion of the ulnar artery coexists with thrombosis, the hypothenar hammer syndrome, a rare clinical entity effecting primarily male manual laborers, can be recognized [2], [3]. Clinically, aneurysms typically present as tense, usually painless pulsatile masses, located in the palmar region of the hand. High-resolution duplex color Doppler examination is useful in confirming the diagnosis of palmar aneurysm. Duplex color Doppler is a noninvasive test, which allows the examiner to evaluate the damage to the vessel wall and the presence of a hematoma. Angiography is currently the “gold standard” in aneurysmal diagnosis providing crucial information for preoperative planning such as location, size and shape of the arterial lesion in question, as well as the presence of any collateral circulation [4]. Several modalities of treatment for hand aneurysms exist and include both conservative and surgical options. In his or her decision making process the clinician should consider such variables as aneurysm location and etiology, symptoms and possible treatment complications. Conservative methods of treatment which include a low calorie diet, and intravenous administration of prostaglandin E1 and vasodilatation agents, have been suggested by some as the first line of therapy. On the other hand surgical treatment is preferred in cases of serious damage to the artery witch may compromise blood supply to the digitis. Surgical techniques include excision of the aneurysm followed by either arterial ligature or arterial reconstruction, and depend, in part, on the size and the localization of the aneurysm and on the presence of ischemic symptoms distally from the vessel lesion [5]. Some experts are even more restrictive in their inclusion criteria for surgical intervention, only advocating surgery for cases of ulnar artery embolization or fusiform deformity (with or without peripheral symptoms), in order to prevent digital artery embolism.