A Primer on the Lost Art of Hand Angiography : Anatomy, Technique, and Clinically Relevant Images

After reviewing this poster, the reader will be able to:

-describe the arterial anatomy from the aortic arch to the fingertips

-recognize common variants of the upper extremity arterial anatomy

-describe how to carry out an angiogram of the upper extremity

-recognize common pathology of the upper extremity and hand

Background:

Background

Upper extremity angiography was historically used as the primary method of diagnosing arterial pathology of the upper extremity and hand. Angiography continues to be the gold standard due to superior spatial and temporal resolution as well as ability to therapeutically intervene. However, PubMed publication data regarding angiography demonstrates conventional angiography has been largely replaced by MRI and CT angiography. 

Due to local practice variation and dominance of MRI/CT angiography, an experienced, competent interventional radiologist may be faced with the daunting task of assisting a hand surgeon in making a diagnosis or informing a treatment choice with little relevant experience in upper extremity angiography. This poster is meant for both the above noted attending, and with sequential review as a learning tool for the neophyte.

Clinical Findings/Procedure Details:

Arterial anatomy- to be presented in pictorial form

Variant anatomy- to be presented in pictorial form

Technique- Described sequentially from access to closure. (Length too long for character limit). Includes tips, trouble shooting techniques, and alternative methods for the vasodilated angiogram.

Common pathology- Annotated high resolution images demonstrating findings of hypothenar hammer, thenar hammer, acute thrombus, scleroderma, and lupus.

Conclusion and/or Teaching Points: After conscientious review of this poster, it is the hope of the authors that the prospect of a hand angiogram, and rendering a clinically meaningful report will be less daunting. The goal is to produce a work that would be posted in reading rooms, as a reference, learning aid, and repository of techniques for this interesting, though infrequently carried out procedure. The takeaways from this poster will be the relevant anatomy, the most common anatomical variants, a stepwise procedure guide, and high resolution images of common pathology.