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Radial or ulnar artery laceration. Repair or ligate?
M Johnson1, M Ford, K Johansen
1Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle.
Objective:
To determine the relationship between patency of radial or ulnar artery repair and later hand symptoms.
Design:
Call-back survey.
Setting:
Urban trauma center.
Patients:
Thirty-two subjects with wrist artery lacerations undergoing 26 arterial repairs and six artery ligations during an 8-year period.
Interventions:
Directed history and hand examination (palpation of wrist pulses, Doppler Allen test, and Doppler interrogation of palmar arch and digital vessels).
Main Outcome Measures:
History of hand claudication, weakness, or cold sensitivity or paresthesias and patency of wrist arteries.
Results:
Twelve (46%) of 26 wrist artery repairs were patent. There was no evident benefit of optical magnification or specialization in hand or vascular surgery. No subjects had hand claudication; there was a 50% incidence of hand weakness and a 12% incidence of cold sensitivity independent of patency of the damaged wrist artery and present only in subjects with associated nerve injury. Professional charges for wrist artery repair were threefold to fourfold higher than those for wrist artery ligation.
Conclusion:
Consonant with prior reports, patency following repair of radial or ulnar artery laceration does not exceed 50%. Later hand symptoms relate to nerve or tendon damage, not to arterial patency. In the absence of acute hand ischemia, simple ligation of a lacerated radial or ulnar artery is safe and cost-effective.