False aneurysm of the common digital artery. Is reconstruction with an arterial graft worth the efforts? A case report

Abstract

False aneurysms in the hand are rare. A false aneurysm of the common digital artery in the palm for the second and third finger is reported, illustrating our experience with arterial graft reconstruction after excision as a valid alternative surgical therapy to a vein graft, when ligation or end-to-end anastomosis are not indicated or feasible. The superficial palmar branch of the radial artery was chosen as donor vessel based on the similarity in vessel diameter and wall thickness to the common digital arteries. Ease of harvesting and performing the microvascular anastomosis using an arterial graft allows for a viable reconstruction after false aneurysm excision in the palm.

Surgical Reconstruction of Traumatic Pseudoaneurysm of Palmar Arch Caused by Blunt Trauma

“…Our study is the first case report of a traumatic PA of the palmar arch managed with the interposition of an autologous vein graft in the literature. Regarding the non-autologous bypass option, only one study was reported by Lucchina et al [19] describing the use of an artery graft interposition for the reconstruction of a digital artery PA, which remained patent during the 3-month follow-up period. Although surgical repair is currently considered the gold standard treatment, endovascular techniques such as coil embolization and ultrasound-guided thrombin injection have emerged as promising alternative minimally invasive solutions for treating superficial and deep palmar arch aneurysms [3,10,20].…”

“…The most common etiological factor for the development of PAs is trauma (blunt, penetrating, or iatrogenic) [ 1 - 8 , 12 - 20 ]. Differential diagnoses can include lipomas, fibromas, inclusion cysts, sarcomas, and abscess formation due to the retention of foreign bodies, especially after a previous trauma [ 4 , 5 ].…”

CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings

“…They can affect the RA or UA, the palmar arches, and the digital arteries, presenting clinically as a small mass, sometimes occurring several months after the trauma without any pulsatility. When surgery is required, CTA or MRA provides a global assessment of the vascular network required for treatment planning [37,38]. Occlusion of the digital arteries that results from acute blunt trauma is exceptional [18].…”

A Review of Arterial Grafts Used for Microvascular Arterial Reconstruction

“…Publications written in English, or that have abstract in English, were screened for relevance and 13 articles reporting on 55 arterial grafts were found (►Table 1). [6][7][8][9][10][11][12][13][14][15][16] Two retrieved article, 17,18 including a large series by Godina 18 were not included due to the lack of data (number of patients/grafts was not reported).…”