A 62-year-old right-hand-dominant man presented with "few years" history of progressively worsening symptoms along the right fourth and fifth fingers, which included pallor, discoloration, pain, paresthesia, "pins and needles," skin lesions, and ulcerations (that had since healed at surgical evaluation appointment). Magnetic resonance angiography (MRA) showed a 2- to 3-cm segmental occlusion at Guyon's canal and an incomplete superficial arch. After failed conservative management, operative intervention was planned. The authors performed a right-sided ulnar artery reconstruction with a lateral femoral circumflex artery (LCFA) arterial graft and sympathetctomy. Intraoperative indocyanine green (ICG) imaging revealed a larger area of stenosis previously unseen on the preoperative MRA scan. This resulted in the need for a larger incision, diseased artery segmental excision, and ultimately a larger LCFA graft. Since the pathologic segment was larger than previously thought, this enabled a more adequate surgical intervention that otherwise would have been insufficient based on MRA alone. Microsurgical anastomosis was performed, and ICG imaging revealed patent vessels.
See Supplemental Digital Content Figures (available at:
Supplementary Figure S1 (Figure 1): Diseased segment of the right (R) ulnar artery
Supplementary Figure S2 (Figure 2): Intraoperative SPY showing diseased segment of ulnar artery
Supplementary Figure S3 (Figure 3): LCFA isolation and graft preparation
Supplementary Figure S4 (Figure 4): Repaired segment of right (R) ulnar artery with LCFA graft in-place).
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