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Background: Critical ischemia is infrequently encountered in the upper extremity due to the anastomotic network between the radial and ulnar arteries. Anatomic variants, injury, and surgical harvest of either the radial or ulnar arteries is usually well tolerated. The radial artery normally originates from the brachial artery in the antecubital fossa but variants are seen in up to 30% of individuals. The most common variant encountered is a high takeoff of the radial artery arising either from the brachial or axillary artery in up to 15% of the population. Radial artery anatomic variants may not be so well tolerated, however, in patients with tenous end organ perfusion secondary to vasospactic disorders and other comorbidities associated with malperfusion. The purpose of this retrospective review is to determine if there is an association between anatomic variations of the radial artery and clinically significant distal upper extremity ischemia. We hypothesize that there is a higher incidence of high origin of the radial artery in patients with clinically significant ischemia compared to previous anatomic studies in the general population.
Methods: A retrospective review of all patients who underwent upper extremity angiography in the setting of clinically significant hand and digital ischemia at Curtis National Hand Center from 2012 through 2016 was performed. Patients requiring angiogram for ischemia secondary to trauma, known proximal embolic disease, or proximal pathology such as thoracic outlet syndrome were excluded. Data collected included patient demographics, comorbidities including diagnosis of vasospastic disorder, upper extremity angiogram, and treatment. The incidence of anatomic variations of the radial artery in previous anatomic studies performed in the general population and published in the literature was compared to the incidence of high take off of the radial artery in our patients.
Results: During the study period, 26 angiograms were performed for upper extremity ischemia meeting the inclusion criteria. Of these patients, 8 (31%) carried a diagnosis of Raynauds disease or scleroderma. The incidence of high radial artery take off was 38%; with radial artery origin proximal to the antecubital fossa occuring in 10 patients. This is significantly higher than previous anatomic studies (p<0.05). There was no difference in the need for surgical intervention in patients with normal anatomy versus those with a high takeoff of the radial artery.
Conclusion: The incidence of a high takeoff of the radial artery is higher in patients requiring angiogram for distal upper extremity ischemia compared to anatomic studies in the general population. Further study is required to examine how this anatomic variation may compromise the compensatory mechanisms of upper extremity perfusion in the setting of vascular disease.