Ischaemia of the Index Finger and Thumb Secondary to Thrombosis of the Radial Artery in the Anatomical Snuffbox

Abstract

We report on nine patients who presented with spontaneous ischaemia of the index finger and thumb over an 11 year period. Arteriography revealed thrombosis of the radial artery in the region of the anatomical snuffbox with evidence of digital artery embolization in each. None had suffered direct trauma to the area or had a demonstrable proximal source for thrombus. While the cause of radial artery thrombosis in our patients in not entirely clear, local inflammation and/or systemic disease may predispose to this entity.

Ischemia of the hand secondary to radial artery thrombosis: A report of three cases

“…Direct trauma is a well-documented cause of radial artery thrombosis among baseball players and workers who frequently receive impacts at their thenar eminences (4,8). It is possible that Case 1, an otherwise healthy patient, fits this category because he reportedly banged the dorsum of his hand with a piece of metal.…”

“…Radial artery thrombosis, though extremely rare, has been reported in its deep branch where the artery crosses the dorsal ridge of the trapezium and from just proximal to the origin of the princeps pollicis artery to just distal to the superficial palmar branch of the radial artery (1,2,(4)(5)(6)(7)(8). Thrombosis may arise due to a wide variety of causes including iatrogenic cannulation, emboli, atherosclerosis or blunt and penetrating trauma (4,5,9).…”

“…Thrombosis may arise due to a wide variety of causes including iatrogenic cannulation, emboli, atherosclerosis or blunt and penetrating trauma (4,5,9). Cannulation of the radial artery results in endothelial injury, thus, exposing subendothelial collagen leading to platelet adherence and subsequent thrombus formation (3).…”

“…External compression of the radial artery may also lead to sludging of the blood and subsequent thrombosis. McNamara et al (4) showed that in four of nine patients who suffered nontraumatic radial artery thrombosis, the radial artery was 'caught' between the extensor pollicis longus tendon and the trapeziometacarpal joint. Ganglionic cysts have also been implicated as sources of compression (3).…”

Anatomical Snuffbox and it Clinical Significance: A Literature Review

“…McNamara et al (1998) noted that between 1984 and 1995, nine patients were treated with spontaneous thrombosis of the radial artery in the region of the AS, all of whom had ischemic symptoms in the index finger and / or the thumb.…”