iloprost and Aneurysm

A 69-year-old amateur carpenter complained of a sudden stabbing pain and a white discoloration of D4 and D5 of the right hand while shoveling snow. On admission in our clinic twelve days later, clinical inspection showed a gangrene of the distal bone of D5 and proximal garland-shaped radial and ulnar subcutaneous haemorrhage and already ischemic contracture. D4 showed pale livid colour.. According to the results of an arteriography acral pulse oscillography revealed a occlusion of the digital arteries. Duplex sonography showed a thrombotic occluded aneurysm of the right ulnar artery over the hypothenar area.. Hypothenar hammer syndrome with a thrombotic occlusion of an aneurysm of the distal ulnar artery and multiple thromboembolic occlusions of the digital arteries of D4 and D5 of the right hand.. After initial therapy with Iloprost, treatment of pain and local treatment, an intraarterial locoregional lysis therapy with urokinase was performed. Acral blood circulation improved significantly and the patient was completely painless after treatment.. In case of an acute onset of unilateral digital ischemia hypothenar hammer syndrome should be considered. Regional thrombolysis can be performed in case of severe digital ischemia.

Topics: Acute Disease; Aged; Aneurysm; Angiography, Digital Subtraction; Fingers; Humans; Iloprost; Ischemia; Male; Plasminogen Activators; Platelet Aggregation Inhibitors; Syndrome; Thrombosis; Ulnar Artery; Ultrasonography, Doppler, Duplex; Urokinase-Type Plasminogen Activator; Vasodilator Agents