Treatment of Superficial Palmar Arch Aneurysms in the Hand

Treatment of Superficial Palmar Arch Aneurysms in the Hand To the Editor: Reading the paper by Yaghoubian and de Virgilio,1 I could not help but notice that the authors presented this case as being unusual. The paper by Rieck et al.2 in 1996 already describes that superficial palmar arch aneurysms are much more common then digital aneurysms. Their review found 48 true and 57 false aneurysms in the literature, at the superficial arch level. Since then, more have been described. Furthermore, at this level these aneurysms cannot possibly be due to radial artery cannulation. An arterial cannula is placed distal to proximal in the radial artery, at the level of the distal radius. Anatomically, this aneurysm is located in the superficial palmar arch, which is located almost at the carpometacarpal joint level. Therefore, this cannot be one of the causes. I do not agree with their choice of not treating the patient. As is well known from aneurysms occurring elsewhere in the body, thrombi could form and occlude either the artery to the thumb or the remaining arch or other fingers, putting more fingers at risk for ischemia. Digital replantations are performed at a much more distal level, with a smaller diameter of the arteries than the

palmar arch has at this level. Long established microsurgical techniques enable us to isolate the aneurysm with microvascular clamps, preventing it from releasing thrombi, and subsequently to excise the aneurysm. The defect can easily be vein-grafted, and it should be possible to anastomose the princeps pollicis artery end-to-side to the superficial palmar arch. This option is much safer than leaving the aneurysm in place, especially since the princeps pollicis artery arises from the aneurysm. Erik T. Walbeehm Department of Plastic and Reconstructive and Hand Surgery, Erasmus MC University Medical Centre Rotterdam Rotterdam, the Netherlands E-mail: [email protected] REFERENCES 1. Yaghoubian A, de Virgilio C. Noniatrogenic aneurysm of the distal radial artery: a case report. Ann Vasc Surg 2006;20: 784-786. 2. Rieck B, Mailander P, Kuske M, Machens HG, Berger A. True aneurysms of the palmar arch of the hand: a report of two cases. Microsurgery 1996;17:102-105.

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