Post-traumatic ulnar artery thrombosis: outcome of arterial reconstruction using reverse interpositional vein grafting at 2 years minimum follow-up.

PURPOSE

Treatment of posttraumatic symptomatic ulnar artery thrombosis (UAT) is controversial. This study reports the outcome at 2 years minimum follow-up of a uniform approach using reversed interpositional vein grafting to treat symptomatic patients with UAT.

METHODS

The records of all patients with vascular disease of the upper extremity who were revascularized at the authors' institution were retrospectively reviewed, and the following inclusion criteria were applied: (1) arteriographically proven UAT treated with excision of the involved segment and reversed interpositional vein grafting; (2) absence of collagen vascular disease, coagulopathy, or peripheral vascular disease, (3) minimum follow-up of 24 months. Twelve patients (13 hands) were identified and evaluated before surgery and at final follow-up using the following health-related quality of life outcome instruments: (1) McCabe cold sensitivity severity scale, (2) McGill visual analog pain scale, (3) Levine symptom and function scale, and (4) Wake Forest University symptom scale (pain, numbness, and cold intolerance). Digital microvascular perfusion testing (laser Doppler perfusion imaging and isolated cold stress testing) was also performed, and the final test was compared with 28 normal controls. All patients were evaluated for graft patency as determined by Allen's testing and/or Doppler ultrasound.

RESULTS

Ten of the 13 grafts were patent at final follow-up (77% patency rate). In all the patients with patent grafts, the Levine symptom scale, the McGill visual analog pain scale, the McCabe cold sensitivity severity scale, and the isolated cold stress testing responses of the patients were significantly improved at final follow-up. Isolated cold stress testing responses were not different from those of normal controls. The changes in the Levine function scale, Wake Forest University scale, and laser Doppler perfusion imaging were not significant. In the nonpatent grafts (3 of 13), 2 patients still complained of pain, numbness, and cold sensitivity, whereas 1 patient has minimal symptoms and continues to improve.

CONCLUSIONS

Successful arterial reconstruction in symptomatic posttraumatic UAT decreases symptoms, improves function and microvascular physiology, and has a positive effect on the health-related quality of life.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.