Updated: 5/22/2021

Digital Artery Aneurysm

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
0%
0%
Evidence
4
0
0
0%
0%
Videos / Pods
1
Topic
Images
https://upload.orthobullets.com/topic/12282/images/pseudoaneurysm_moved.jpg
https://upload.orthobullets.com/topic/12282/images/nfig002.jpg
https://upload.orthobullets.com/topic/12282/images/nfig001.jpg
  • Introduction
    • Aneurysm is defined as a permanent dilation of an artery with a 50% increase in its normal diameter
  • Epidemiology 
    • Incidence
      • rare
        • < 1 per 100,000
  • Etiology
    • Pathophysiology
      • traumatic
        • true aneurysm
          • blunt trauma weakens the arterial wall causing it to dilate
            • appear more uniform in shape
        • false aneurysm (e.g. pseudoaneurysm)
          • pentrating trauma to arterial wall replaced by organized hematoma and fibrous wall
            • appear more 'sac-like' in shape
      • non-traumatic
        • inflammatory
        • atherosclerotic
  • Presentation
    • History
      • recent blunt or penetrating hand trauma
    • Symptoms
      • slow-growing painful mass
      • many be sensory disturbance due to compression of adjacent digital nerve
    • Physican exam
      • palpable mass
      • may be pulsatile in ~ 50% of cases
      • may occur in any of the 5 digits
        • most common in thumb > index > ring finger
  • Imaging
    • Radiographs
      • indication
        • usually not helpful
        • concern of destructive lesion
      • findings
        • usually normal
    • Doppler ultrasound or angio–computed tomography (CT) scan
      • indication
        • pre-operative confirmation
      • findings
        • size and location of lesion
        • thrombus formation
        • collateral circulation
  • Differential
    • Arteriovenous fistulas
    • Neurilemmomas
    • Foreign body granulomas
    • Ganglions
    • Epidermoid cysts
  • Treatment
    • Nonoperative
      • observation and analgesics
        • indications
          • small, asymptomatic lesions
      • ultrasound-guided thrombin injection
        • indications
          • some reports use this techique in lesions arising more proximal in the hand or wrist.
    • Operative
      • surgical exploration and ligation
        • indications
          • symptomatic lesions with adequate collateral circulation
        • technique
          • ligation performed proximal and distal
      • repair with interpositional grafting
        • indications
          • symptomatic lesions with inadeaquate collateral circulation
  • Techniques
    • Digital artery aneurysm repair
      • end-to-end anastomosis and an autogenous interpositional vein or arterial graft
  • Complications
    • Digital ischemia
    • Chronic pain
Flashcards (0)
Cards
1 of 0
Questions (1)

(OBQ06.208) A 47-year-old female presents with a pulsatile mass in the palm of the hand and intermittent paresthesias a few weeks after a traumatic laceration in a kitchen accident. A contrast-enhanced MRA of the mass is seen in Figure A. What is the most appropriate treatment?

QID: 219
FIGURES:
1

Aspiration

1%

(16/3139)

2

Surgical exploration

87%

(2735/3139)

3

Compression bandage

7%

(208/3139)

4

Steroid injection

1%

(18/3139)

5

Strict elevation and observation

5%

(142/3139)

L 2 D

Select Answer to see Preferred Response

Evidence (4)
VIDEOS & PODCASTS (2)
EXPERT COMMENTS (1)
Private Note