Hypothenar hammer syndrome: management of distal embolization by intra-arterial fibrinolytics.

We report a case of hypothenar hammer syndrome. The ulnar artery aneurysm was resected and a complete thrombectomy of the superficial palmar arch, the common digital and the proximal part of the collateral digital arteries was carried out. The arterial defect of the ulnar artery was repaired by a vein graft. Post-operatively, no clinical improvement was observed on the vascularisation of the second and third fingers. The arteriogram confirmed the presence of arterial obstruction on the distal part of the digital collateral arteries of this two fingers. The finger pulp started to show areas of skin gangrene and in view of the risk of finger necrosis, we decided to use fibrinolytics. This embolic events was dissolved by continuous fibrinolytic and anticoagulant intra-arterial infusion. The treatment was maintained for ten days restoring a normal digital vascularisation.