Introduction: Ischaemia in the distal upper extremity causes severe pain and digital ulceration. These changes are seen in chronic conditions such as scleroderma but may be precipitated by trauma. We present the use of a deep inferior epigastric artery interposition graft for radial artery insufficiency. In this case existing vaso-occlusive changes from scleroderma were exacerbated by iatrogenic damage to the radial artery during fixation of a distal radius fracture.
Case Report: A 43-year-old female with a history of limited scleroderma and severe Raynaud’s sustained a distal radius fracture 5 years earlier. Following volar plating she experienced severe pain and digital ulceration. This resulted in terminalisation of the middle fingertip and debridement of the index and thumb. Botox, iloprost infusion and attempted recanalisation provided only limited short term relief. Venous bypass had been attempted by the vascular team but had been unsuccessful. Following her deep inferior epigastric artery grafting she has improved perfusion, resolution of pain and healing of a chronic ulcer on her index finger. The plate was removed during the same operation which revealed that there had been iatrogenic injury to the radial artery during plating.
Discussion: Management of vascular insufficiency of the hand is challenging. Veins are considered inferior for grafting due to size mismatch, valves and being more difficult to handle. Arterial long term patency rates are superior. The deep inferior epigastric artery has predictable anatomy, provides on average 12cm of length and can be accessed with the patient supine. It creates minimal donor morbidity and is expendable.
Conclusion: Arteries provide a superior graft. The deep inferior epigastric artery is a reliable donor for arterial grafting. This case further illustrates its utility for the treatment of arterial insufficiency of the upper extremity.