Successful revascularization for delayed presentation of radiation-induced distal upper extremity ischemia

Despite several reports of proximal arm ischemia due to radiation therapy, there are no reports of hand ischemia, presumably due to the rarity of radiation treatment of the distal upper extremity. We present a case of a 42-year-old male presenting with acute hand ischemia 36 years after being treated with forearm radiation for Ewing's sarcoma. Angiography demonstrated a patent brachial artery, occluded radial and ulnar arteries in the forearm, and a normal-caliber reconstituted radial artery at the anatomical snuffbox feeding a patent palmar arch. Transluminal balloon angioplasty was attempted initially without improvement. The patient was successfully revascularized with a reversed saphenous vein graft bypass from the distal brachial artery to the distal radial artery. At 22 months of follow-up, the graft remains patent with a palpable distal pulse. The patient continues to report acceptable function and range of motion.