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Radial artery entrapment syndrome
M Sean Mcmurtry, Piotr Sobieszczyk, Michael Belkin, Marie D Gerhard-Herman
To cite this version:
M Sean Mcmurtry, Piotr Sobieszczyk, Michael Belkin, Marie D Gerhard-Herman. Radial artery entrapment syndrome. Vascular Medicine, SAGE Publications, 2008, 13 (3), pp.297-298.
�10.1177/1358863X08091148�. �hal-00571380�
Images in vascular medicine
Radial artery entrapment syndrome
M Sean McMurtry1, Piotr Sobieszczyk2, Michael Belkin3and Marie D Gerhard-Herman2
A 35-year-old previously well man presented with right upper extremity digital ischemia and ulceration. Baseline blood work, including a screen for connective tissues dis- eases, was normal. A 12-lead EKG and a transthoracic echocardiogram with bubble study were also normal.
Non-invasive magnetic resonance (MR) angiography demonstrated unilateral arterial insufficiency of the right hand (Panel A-1: left hand; Panel A-2: right hand). Inva- sive angiography confirmed abnormal right hand arterial supply with obliteration of digital arteries (Panel B-1), while the left hand was normal (not shown). An apparent stenosis (arrows) was observed in the proximal right radial artery with the arm in the neutral position (Panel B-2), which worsened with pronation with con- comitant flow reduction (Panel B-3). Persistent contrast staining was seen in the post-stenotic region, consistent with very low flow and a possible propensity for throm- bosis. Intravascular ultrasound (IVUS) of the apparent stenosis was performed, which demonstrated external compression rather than a luminal stenosis (not shown).
Vascular ultrasound confirmed decreased flow with pro- nation and an aberrant brachioradialis tendon (T) that tracked over the radial artery (R) and caused compres- sion (not shown). This finding was confirmed at surgery (Panel C-1: initial anatomy), and corrected by moving the radial artery course over the tendon (Panel C-2: postoper- ative anatomy). Distal embolism was the presumed mechanism of digital ischemia, and the patient’s ulcers healed postoperatively.
Arterial entrapment more commonly occurs in the lower extremity with entrapment of the popliteal artery by surrounding musculotendinous structures, but also may occur in the upper extremities as this case demon- strates. Radial artery entrapment has been reported pre- viously as a rare complication of an orthopedic injury such as posterior dislocation of the elbow,1 or of
repeated hemodialysis fistulae thrombosis,2and usually involves neurologic symptoms. Our case of radial artery entrapment due to an overlying aberrant tendon present- ing as digital ulcers is a rare presentation of a rare problem.
Panel A
1Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada; 2Vascular Medicine Section, Brigham and Women’s Hospital, Boston, MA, USA;
3Vascular Surgery Section, Brigham and Women’s Hospital, Boston, MA, USA
Correspondence to: M Sean McMurtry, Assistant Professor of Medicine, University of Alberta, 2C2 Walter Mackenzie Health Sciences Center, 8440, 112th Street, Edmonton, Alberta, Canada T6G 2B7. Email: mcmurtry@ualberta.ca Panel C is available to view in color online at http://vmj.sage- pub.com
Vascular Medicine2008;13:297–298
© 2008 SAGE Publications, Los Angeles, London, New Delhi and Singapore 10.1177/1358863X08091148
References
1 Pearce, MS. Radial artery entrapment. A rare complication of posterior dislocation of the elbow. Int Orthop 1993;17: 127–128.
2 Chemla, ES, Raynaud, A, Mongredien, B, et al. Forearm arteries entrapment syndrome: a rare cause of recurrent angioaccess thrombosis.J Vasc Surg2001;34: 743–747.
‘
Images in vascular medicine
’is a regular feature of
Vascular Medicine. Readers may submit original,unpublished images related to clinical vascular medicine to: Mark A Creager, Editor in Chief,
Vascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
Panel C Panel B
298 MS McMurtry et al.
Vascular Medicine2008;13:297–298
