title: [Distal ischemia of the upper limb due to obliteration of the ulnar artery at the wrist: surgical treatment].
abstract: So-called "Raynaud's distal ischaemic phenomena of the upper limb may be responsible for disabling functional impairement and even lesions requiring amputation of one or several fingers. The ulnar artery is usually involved in these phenomena because of its anatomical position and its importance in the blood supply of the hand and the fingers. The authors present three clinical cases of distal ischaemia of the upper limb due to obliteration of the ulnar artery at the wrist, treated by microsurgical vein graft. A review of the literature revealed only 23 well documented cases of this type of treatment, i.e. 10% of all treatment options, which gave 95 to 100% of favourable results. The three patients in our series, reviewed after 2, 3 and 5 years, were considered to be cured. Although the severity of the disease can be evaluated by the clinical course, arteriography appears to be the key examination for diagnosis, prognosis and choice of treatment. However, two practical attitudes are recommended to avoid the risk of progression towards digital necrosis: when the symptoms are chronic, arteriography is indicated in the case of resistance to medical treatment or immediately in the case of unstable symptoms. The diagnosis of occlusion of the ulnar artery at the wrist then justifies treatment by microsurgical vein graft; when the symptoms are acute, treatment should preserve as much as possible the palmar and digital ulnar arterial blood supply.
authors.affiliation: Service de Gynécologie-Obstétrique, Hôpital Jean Bernard, CHU, Poitiers.
authors.forename: J B
authors.initials: JB
authors.lastname: de Meeus
authors.forename: G
authors.initials: G
authors.lastname: Duport
authors.forename: P
authors.initials: P
authors.lastname: Lacroix
authors.forename: L E
authors.initials: LE
authors.lastname: Gayet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D011928:Raynaud Disease / Q000150:complications*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000592:standards; D014680:Veins / Q000637:transplantation*