Updated: 10/5/2016

Digital Artery Aneurysm

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Questions
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Evidence
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Introduction
  • Aneurysm is defined as a permanent dilation of an artery with a 50% increase in its normal diameter
  • Incidence
    • rare
  • 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
  • Often misdiagnosed as
    • epidermoid cysts
    • arteriovenous fistulas
    • forieign body granulomas
    • ganglions 
    • neurilemmomas
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
 

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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? Review Topic | Tested Concept

QID: 219
FIGURES:
1

Aspiration

1%

(15/2906)

2

Surgical exploration

87%

(2538/2906)

3

Compression bandage

7%

(189/2906)

4

Steroid injection

0%

(14/2906)

5

Strict elevation and observation

5%

(132/2906)

L 2 D

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Evidences (4)
VIDEOS (1)
Topic COMMENTS (1)
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