Acute Digital Ischaemia - What the Radiologist Needs to Know

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Abstract

Abstract
Digital ischaemia is an uncommon pathology with multiple aetiologies, many of which are poorly understood. Imaging plays an important part in diagnosing curable causes. Digital substraction angiography (DSA) remains the gold standard for the study of the pathology of digital ischaemia. However, the improved spatial resolution and 3D image-processing tools of computed tomographic angiography (CTA) have led to its more recent application in the analysis of small and distal vessels. CTA is advantageous in that it provides both luminal and soft tissue imaging. It also yields a precise anatomical depiction of the vascularisation of the hand: the structure of the palmar arch is highly variable, an understanding of which is crucial when considering the source of blood supply to the arteries of the fingers. Here, we present a retrospective study of 32 patients with typical cases of the main aetiologies of digital ischaemia, all of whom underwent DSA. Eight patients suspected of hypothenar hammer syndrome additionally underwent CTA. In this study, we promote the use of CTA as a minimally invasive technique to clearly describe the localisation and extent of vessel injury.

Keywords
Digital ischaemia, hypothenar hammer syndrome, computed tomographic angiography (CTA), digital substraction angiography (DSA), palmar arch, thrombosed aneurysm

Disclosure: The authors have no conflicts of interest to declare.


Received: 2 September 2010 Accepted: 11 November 2010 Citation: European Cardiology, 2011;7(1):10-3


Correspondence: Myriam Edjlali-Goujon, Centre d Innovation Technologique, Centre Hpitalier R®gional et Universitaire Tours, Hospital Bretonneau, 2 Boulevard Tonnell®, 37044 Tours, France. E: myriam.edjlali@gmail.com

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Digital ischaemia is an uncommon pathology, with an incidence of two cases per 100,000 people per year.1 Diagnosis is mainly based on clinical symptoms: the patient presents a painful digital extremity with signs of ischaemia (blue finger) or even necrosis. Clinical context and medical history are also important to determine the aetiology of digital ischaemia.

The role of imaging modalities is central to the localisation and prediction of the severity of vascular lesions. Intra-arterial digital substraction angiography (DSA) is considered the gold standard for the study of vascular extremities. Furthermore, non-invasive imaging of distal small vessel disease has been developed over recent years; in particular, computed tomographic angiography (CTA) of the upper extremity.

Fewer than 20 significant publications are reported on MEDLINE on this subject and most of them were written before 1990.2 We present here a retrospective study of 32 patients with digital ischaemia who were referred to the "hand emergency service™ of Tours University Hospital, France, between August 2006 and August 2009. All 32 patients underwent DSA. In addition, eight patients with suspected hypothenar hammer syndrome underwent CTA, specifically to look for an ulnar artery aneurysm.

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