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Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The continuation of the ulnar artery then forms, distally, the superficial palmar arch, which gives rise to the common digital arteries that in turn give rise to the proper digital arteries (Figure 4.4). The continuation of the radial artery forms, distally, the deep palmar arch, which is connected via the superficial palmar branch of the radial artery to the superficial palmar arch (Plates 4.17b and 4.18). A clinically important feature of the radial artery is that it passes through the anatomicalsnuffbox—enclosed by the tendons of the extensor pollicis brevis and extensor pollicis longus (Plate 4.15)—to reach the dorsum of the hand. Then the artery returns to the palmar surface by passing between the heads of the 1st dorsal interosseous muscle. In the palm, it then gives rise to the deep palmar arch and to a distinct artery for the thumb: the princeps pollicis artery.
Pediatric hand trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Jeffrey G. Trost, Ann L. Licht, John D. Potochny, Larry H. Hollier
The deep palmar arch gives off the palmar metacarpal arteries. These, in turn, become the digital arteries that travel alongside corresponding digital nerves along the volar aspect of each side of the fingers. The ulnar artery supplies two additional named arteries that supply the thumb muscle and index finger, namely, the princeps pollicis artery and the radialis indicis artery, respectively. The princeps pollicis artery runs between the flexor pollicis brevis muscle and the tendon of the FPL while the radialis indicis artery travels along the radial side of the index finger. Finally, tendons receive their blood supply in the digits from vincula, folds of mesotendon that contain small blood vessels and may additionally act as anchors to prevent proximal retraction of a severed tendon. When there is a question of injury, a Doppler should be used to test for a signal.
Peripheral vascular angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The subclavian artery extends to the lateral border of the first rib. Its course is divided into three segments based on the relationship of the artery to the scalenus anterior muscle. The first segment provides the most important branches of the subclavian artery, the vertebral, internal mummeries, and the thyrocervical trunk. The vertebral artery rises from the proximal subclavian artery. Typically, there is one dominant vertebral artery. It may be the right or the left one. In rare cases, the left vertebral artery may arise directly from the aortic arch (less than 5%). The subclavian artery continues into the axillary artery. The axillary artery borders extend from the lateral aspect of the first rib into the head of the humorous (Figure 25.4). The vessel beyond this point will be defined as the brachial artery. The brachial artery used to be a common access point for a variety of pro- cedures, including left heart catheterization. This access has been widely replaced for coronary angiography and revascu- larization and is being used increasingly also for peripheral procedures. The brachial artery provides two major vessels with the radial and ulnar arteries (Figure 25.5). Contrary to lower extremity anatomy, the profunda brachii artery splits from the brachial artery and tends to have no significant clinical impact on the arm muscles (Figure 25.6). The ulnar artery bifurcates medially from the brachial artery. The ulnar artery tends to be the more dominant vessel. The bifurcation starts at the neck of the radius. It provides the intraosse- ous artery that runs more laterally supplying the intraosse- ous membrane with the forearm muscles. The ulnar artery carries on through the pisiform carpal bone. It eventually reaches the hand and is the major supplier of the superficial arch. The radial artery is a smaller vessel. After it bifurcates from the brachial artery, it runs as the most lateral vessel toward the styloid process of the radius. The ulnar artery supplies the deep palmar arch and the superficial palmar arch is supplied by the radial artery. The common digital arteries arise from the superficial and deep arches and sup- ply the interdigital space. These vessels are usually spared from atherosclerosis. However, some patients with advanced renal disease and diabetes may have significant obstructions and/or calcifications (Figure 25.7).
Spontaneous necrosis of a single digit: watershed necrosis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Alain J. Azzi, Gabriel Bouhadana, Fanyi Meng, Peter G. Davison
Classically, the radial and ulnar arteries enter the hand and anastomose across the palm to form the superficial and deep palmar arches. Normally, the main supply of the deep palmar arch (DPA) is the radial artery, whereas the superficial palmar arch (SPA) is ulnar-dominant. The DPA usually branches to form the princeps pollicis and the radial digital artery of the second digit. The SPA gives off the ulnar digital artery of the fifth digit and the common palmar digital arteries in the second, third and fourth web spaces. Vascular redundancy and interconnections render the blood supply to the hand and digits robust. Examples include interconnections between the deep and superficial arches, between the palmar metacarpal arteries and the digital arteries, between the dorsal metacarpal arteries and the digital arteries, etc. Anatomical variations are common and do not usually pose a risk to digit blood supply due to this network of interconnections. We present a case of spontaneous ‘watershed’ necrosis of a single digit caused by arterial disease, a pathology that would have otherwise been benign in patients with normal anatomy. To our knowledge, this mechanism of digit necrosis has yet to be reported in the literature.
Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety
Published in Libyan Journal of Medicine, 2021
Rania Hammami, Fatma Zouari, Mohamed Aymen Ben Abdessalem, Awatef Sassi, Tarek Ellouze, Amine Bahloul, Souad Mallek, Faten Triki, Abdallah Mahdhaoui, Gouider Jeridi, Leila Abid, Selma Charfeddine, Samir Kammoun, Jihen Jdidi
Radial artery occlusion is the most common complication of conventional radial access; it’s reported by different authors to occur in 1.5–33% of cases, shortly after the procedure [17]. The true incidence could be underestimated because it is asymptomatic in the majority of cases [18], fortunately this complication isn’t definitive and the occlusion is reversible in 60% of cases within 1–3 months [19]. In our study, three cases (3%) of proximal radial artery occlusion, detected by ultrasonography, were reported in the CRA group and no one in the DRA group. In fact, the site of puncture in anatomical snuffbox is located beyond the bifurcation into the deep palmar arch and in case of occlusion of distal radial artery, the flow of proximal radial artery will be provided by the superficial palmar arch. In series of DRA, local radial artery within the anatomical snuffbox occlusion rate was noted in only 0–3.1% of cases [5,20,21] and forearm radial artery occlusion was showed in less than 0,5% of cases [20]. Thus, DRA seems to be safely in hemodialysis patients and candidates for coronary bypass who required radial graft [22]. In the recent meta-analysis comparing conventional and distal radial access, the rate of radial artery occlusion was lower with DRA (2.30 versus 4.86%, RR = 0.51; 95%CI 0.32–0.81; p = 0.004) as compared to CRA, the risk of this complication was reduced by half.
Update on complications and their management during transradial cardiac catheterization
Published in Expert Review of Cardiovascular Therapy, 2019
Joe Aoun, Laith Hattar, Khabib Dgayli, Gordon Wong, Tariq Bhat
The hand circulation, which was previously described as a simple dual supply, is in fact more complex. The ulnar and radial arteries subdivide into two branches each. The superficial branch of the radial artery merges with a branch of the ulnar artery in order to form the superficial palmar arch. The dorsal branch of the radial artery merges with the deep palmar branch of the ulnar artery in order to form the deep volar arch. In about 12% of cases, the deep palmar arch can also be supplied by the interosseous artery bypassing both ulnar and radial arteries [36]. Due to the redundant and robust arterial supply of the hand, symptomatic RAO is a rare entity with limited data. The main pathophysiology of symptomatic RAO is linked to a normal variant of the vascular anatomy consisting of incomplete anastomosis between the deep palmer arch supplied mainly by the radial artery and the superficial arch supplied mainly by the ulnar artery [37,38]. Critical limb ischemia (CLI) is a rare but very concerning finding with catastrophic end results, if not managed appropriately in a timely manner [39]. Multiple case reports have been described and included patients with raynaud’s phenomenon and intra-procedural spasm [40–42]. Angioplasty of the RAO via a brachial approach can be used for treatment [43]. In severe cases, urgent fasciotomy is indicated [44]. Secondary screening protocols have not been established for prevention as the risk remains extremely low. The use of Allen’s test or Barbeau test pre-transradial cardiac catheterization has been questioned. In 2018, the AHA does not recommend the use of Allen’s or Barbeau test for access-site triage as it does not predict outcomes [11]. The RADAR study compared the feasibility and safety of TRA in patients with abnormal, intermediate and normal Allen’s test (AT) [45]. TRA resulted in improvement of the ulnopalmar flow in patients with abnormal AT, without increased risk of hand ischemia [45,46]. In this perspective, it is reasonable not to perform AT before TRA as the latter can be done safely even in patients with abnormal AT [46].