Revascularization of radial artery for ischemic hand with history of hand reimplantation

Limb reimplantation is widely described, but there are sparse reports of limb-ischemia complications. We present a patient with hand reimplantation who developed limb-threatening ischemia 20 years later. The patient is a 37-year-old male with history of traumatic wrist amputation and reimplantation who presented with finger-tip ulcerations. Testing demonstrated ischemic digit-pressures and no flow in the palmar arch. Initial angiogram demonstrated radial artery occlusion. Balloon angioplasty had initial success, but loss of primary-patency prompted repeat angiography with use of intravascular ultrasound (IVUS) and laser atherectomy. Symptoms and wounds resolved, with digit-pressures normalized. His radial artery remains patent after two years.