I. General Information
A. Anatomy (
Figure 1)
1. The ulnar artery is dominant in 88% of individuals, the radial in 12%.
2. The radial artery is the predominant contributor to the deep palmar arch.
[Figure 1. Palmar view of the vascular anatomy of the forearm and hand.]
3. The ulnar artery divides into superficial and deep branches. The deep branch joins the radial artery to form the deep arch, and the superficial branch gives rise to the superficial palmar arch.
4. The volar digital arteries arise from the superficial arch.
5. A persistent median artery is found in 10% of individuals.
B. Diagnostic studies
1. Doppler can evaluate perfusion.
2. Arteriography is the gold standard.
II. Ulnar Artery Thrombosis
A. General information
1. Most common vascular occlusive disease of the upper extremity.
2. Most common in men 50 to 60 years of age.
3. Thrombosis occurs in the Guyon canal as a result of repetitive trauma.
4. Sympathetic fibers to the ulnar artery at the level of the Guyon canal are derived from the nerve of Henle.
5. The ulnar artery develops an aneurysm and subsequently thromboses (versus penetrating trauma, which will cause a pseudoaneurysm).
B. Presentation
1. Cold intolerance
2. Sensory dysfunction (decreased sensation and sweating)
3. Little or no motor dysfunction
C. Treatment
1. Activity modification
2. Smoking cessation
3. Calcium channel blockers or β-blockers
4. Intravenous thrombolytics
5. Sympathectomy
6. Thrombectomy with arterial repair or vein graft
D. Complications
1. Cold intolerance typically improves with treatment, but most patients have residual symptoms.
2. Distal emboli and vasospasm are common; resection of the aneurysm is the only treatment for these symptoms.
III. Buerger Disease (Thromboangiitis Obliterans)
A. General information
1. Involves inflammation of medium and small vessels of the hands and feet with thrombosis
2. Diagnosis is made by histology
a. Acute phase: cellular, segmental, occlusive inflammatory thrombi
b. Subacute phase: progressive intraluminal thrombosis
c. End stage: mature thrombi and vascular fibrosis
3. Disease is more severe peripherally
4. Occurs almost exclusively in young male smokers
B. Presentation
1. Severe rest pain and cold intolerance
2. Raynaud phenomenon
3. Digital ischemia and necrosis
C. Treatment
1. Smoking cessation
2. Anticoagulants and vasodilators
3. Vascular reconstruction
4. Amputation
Top Testing Facts
1. The ulnar artery is dominant in 88% of individuals.
2. Ulnar artery thrombosis occurs in men 50 to 60 years of age.
3. Ulnar artery thrombosis is a result of repetitive trauma.
4. Buerger disease occurs almost exclusively in young male smokers.
Bibliography
Koman LA, Urbaniak JR: Ulnar artery insufficiency: A guide to treatment. J Hand Surg [Am] 1981;6:16-24.
Mills JL: Buerger's disease in the 21st century: Diagnosis, clinical features and therapy. Semin Vasc Surg 2003;16:179-189.
Wilgis EF: Digital sympathectomy for vascular insufficiency. Hand Clin 1985;1:361-367.