Vascular Abnormalities in the Hand and Wrist: State-of-the-Art Multimodality Imaging

Vascular abnormalities are less common in the hand and wrist than in the lower extremities but can result in significant morbidity if unrecognized or untreated. The unique vascular architecture of the hand and wrist, with a dense network of arterial anastomoses, confers resilience to ischemia, but the superficial location makes them vulnerable to trauma and occupational injury. The authors describe and illustrate a comprehensive multimodality imaging approach to the diagnosis and evaluation of vascular abnormalities of the hand and wrist. They begin with an overview of vascular anatomy and normal variants, including a persistent median artery. Multimodality imaging, including US, CT angiography, MR angiography, and digital subtraction angiography, is reviewed with a focus on strengths, limitations, and clinical utility. Dynamic imaging techniques and photon-counting CT are highlighted for their evolving roles. A wide spectrum of vascular diseases, including atherosclerosis, trauma, iatrogenic injury, embolism, hypothenar hammer syndrome, hand-arm vibration syndrome, vasculitis, and frostbite, as well as their imaging appearances, are discussed. Vascular anomalies, including vascular malformations and vascular neoplasms, are also reviewed. The role of imaging in hand transplantation is addressed. The authors provide a framework for recognizing vascular diseases in the hand and wrist and selecting the appropriate imaging modality. Familiarity with vascular anatomy, imaging findings, and clinical context is essential for timely diagnosis, guiding management, and preserving limb function.