Diagnostic and management strategies for pseudoaneurysm of the ulnar artery: A scoping review.

Abstract

Introduction: Pseudoaneurysm of the ulnar artery (PUA) can arise secondary to several inciting etiologies and may lead to pain, arterial insufficiency, and ulnar nerve palsy. Given the relative infrequency of PUA diagnosis, there is no consensus regarding its proper diagnosis and management strategies. The purpose of this review is to summarize the existing data regarding PUA and develop an algorithm for management.

Methods: A review was performed following PRISMA Extension for Scoping Reviews guidelines. Manuscripts were included if they 1) studied patients over the age of 18, 2) discussed specifics of the PUA and 3) detailed its management.

Results: Thirty-one manuscripts were included, presenting data on 32 patients with a mean ​± ​standard deviation age of 46.9 ​± ​19.6 years. Ulnar artery injury mechanism included trauma (13/32, 40.6 ​%), iatrogenic (9/32, 28.1 ​%), and inherent connective tissue disease (4/32, 12.5 ​%), among others. Ultrasonography was the most common imaging modality (14/32, 43.7 ​%), and a majority (22/32, 68.8 ​%) of patients were managed surgically, typically via pseudoaneurysm resection ​± ​venous grafting for reconstruction. Non-operative interventions included ultrasound-guided compression therapy and thrombin injection.

Conclusion: While PUA are infrequently diagnosed, inciting events such as accidental or iatrogenic trauma continue to be documented, and management guidelines are lacking. Duplex ultrasonography is recommended as the first line imaging study, with subsequent Allen Test to assess for ulnar artery vs. mixed dominance for hand perfusion. A pseudoaneurysm of 3 ​cm is proposed as a general threshold for considering intervention, with caveats for smaller lesions causing pain or neurologic symptoms. This review serves as a reference for physicians who encounter PUA.