Clinical Example: Retrocarpal radial artery occlusion with finger ischemia

3 cases of hand ischemia associated with radial artery occlusion in the first web space. 

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Case 1.
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Case 2: more severe problem: ulnar artery is occluded as well. This patient signed out of the ICU AMA to have a smoke (5 pack a day - yeeow!)
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Case 2: The problem with revascularisation at this location is that the distal point of occlusion is at a branch - usually at a fork between the thumb and the palmar arch. Ideally, a distally branching reversed vein graft can supply both points, as was done here (vein graft, dorsal approach to first web space, distal left, thumb superior).
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Case 3: More focal problem, thumb and index ischemia: Arteriogram:
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Case 3: I think that this tight fascial band in the FDIO (Littlers under the left, artery visible to the right) contributed mechanically.
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Case 3: Again, a distally branching vein graft to reconstruct inflow to both thumb and palmar arch.
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