Cheu H W, Mills J L
Vascular Surgery Service, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas 78236-5300.
J Vasc Surg. 1991 Aug;14(2):225-8. doi: 10.1067/mva.1991.28564.
A 74-year-old woman was admitted to the hospital with sudden onset of a blue, painful right index finger, and the condition progressed to digital ulceration. The ulcer gradually healed over a period of 2 months. Peripheral pulses, Doppler-derived brachial and radial systolic pressures, and results of an echocardiogram were normal. Digital pulse volume recordings showed obstructive waveforms in all digits of the right hand. Arteriography showed a normal arch and normal innominate, subclavian, and axillary arteries. The midbrachial artery was markedly abnormal and had alternating areas of stenosis and aneurysm formation. Multiple occlusions involved the palmar arch and proper digital arteries. The abnormal brachial artery segment was excised and replaced with an autogenous reversed saphenous-vein conduit. Histologic examination confirmed the lesion to be medial fibromuscular dysplasia. Fibromuscular dysplasia that involves upper extremity arteries is extremely uncommon and rarely presents with digital artery embolization. This case emphasizes the importance of exclusion of proximal reconstructible arterial occlusive disease by means of complete arteriographic examination of patients who were admitted with unilateral finger or hand ischemia.
一名74岁女性因突发右手食指发绀、疼痛入院，病情进展为手指溃疡。溃疡在2个月内逐渐愈合。外周脉搏、经多普勒测定的肱动脉和桡动脉收缩压以及超声心动图结果均正常。手指脉搏容积记录显示右手所有手指均出现阻塞性波形。动脉造影显示主动脉弓正常，无名动脉、锁骨下动脉和腋动脉正常。肱动脉中段明显异常，有交替出现的狭窄和动脉瘤形成区域。掌弓和指固有动脉多处闭塞。切除异常的肱动脉段，并用自体倒置大隐静脉导管进行置换。组织学检查证实病变为中层纤维肌发育不良。累及上肢动脉的纤维肌发育不良极为罕见，很少表现为指动脉栓塞。该病例强调了对于因单侧手指或手部缺血入院的患者，通过完整的动脉造影检查排除近端可重建动脉闭塞性疾病的重要性。
