Search

Introduccion Mediante estudios anatomicos estaticos, se ha establecido durante anos, que la arteria cubital es dominante para la irrigacion de la mano en un 80% de los casos. Sin embargo, estudios anatomico-radiologicos mas recientes, sobre muestras poblacionales limitadas (n = 27), ponen en duda la dominancia arterial cubital unica de la mano. Por otro lado, el comportamiento funcional adaptativo, tanto de la arteria radial como de la cubital, cuando la otra arteria es obstruida, todavia no ha sido estudiado. Los objetivos del presente trabajo son: (1) Determinar si existe una dominancia arterial en la mano y (2), estudiar las variaciones del flujo que experimentan tanto la arteria radial como la cubital de voluntarios sanos, cuando la otra arteria se obstruye durante la realizacion de la prueba de Allen. Material y Metodo Se realizo un estudio observacional descriptivo transversal, sobre 200 manos de 100 voluntarios sanos. Se recogieron los datos de sexo y lateralidad. Se utilizo un ecografo doppler color para determinar, antes y durante la realizacion de un test de Allen, el diametro transversal, el area de seccion, la tasa y la velocidad de flujo, tanto de la arteria radial como de la arteria cubital. Los datos recogidos se compararon con una prueba de la suma de rangos de Wilcoxon y se realizo un analisis de correlacion mediante la prueba P de Pearson entre las diferentes variables. Resultados No se observaron diferencias significativas entre los diferentes parametros estudiados comparandolos segun la lateralidad y el genero de los voluntarios evaluados. Se evidencio una diferencia estadisticamente significativa para la tasa de flujo, area de seccion y diametro transversal entre la arteria radial y cubital, tanto en reposo como durante la prueba de Allen, siendo mayor los parametros para la arteria radial. Durante la realizacion de la prueba de Allen, se obtuvo una correlacion positiva directa entre el incremento en el diametro, tanto de la arteria radial como de la cubital, y de sus velocidades de flujo; se observo, un aumento en el area de seccion y en la tasa de flujo de ambas al ocluir la otra. Conclusiones Ha quedado evidenciado, por medio de este estudio dinamico de flujo, una dominancia de la arteria radial para la irrigacion de la mano. Tambien ha podido demostrarse que existen cambios adaptativos, anatomicos y funcionales, en la arteria cubital y radial, cuando hay ausencia de la otra. Purpose Through some static anatomical studies, it has been established for years that the ulnar artery is dominant for the hand irrigation in 80% of cases. However, more recent anatomical and radiological studies, undertaken on limited population samples (n = 27), question the unique ulnar arterial dominance of the hand. On the other hand, the adaptive functional behavior of both, the radial and the ulnar artery, when the other artery is obstructed, has not yet been studied. The purposes of this paper are: (1) To determine whether there is an arterial dominance for blood supply in the hand and (2) to study the variations in the blood flow experienced by both, the radial and the ulnar arteries of healthy volunteers, when the other artery is obstructed during the performance of an Allen test. Methods An observational cross-sectional study was performed on 200 hands of 100 healthy volunteers. Data was collected on sex and laterality of the dominant hand. A color Doppler ultrasound was used to determine, before and during the performance of the Allen test, the transverse diameter, the cross-sectional area, the rate and the blood flow velocity, both, in the radial and the ulnar artery. The collected data was compared with a Wilcoxon signed-rank test and Pearson correlation test was used. Results There were no significant differences between the different parameters studied comparing them according to the hand laterality and the gender of the evaluated volunteers. The radial artery blood flow rate, cross-sectional area and transvers diameter data were statistically significantly higher than the ulnar artery's, both, at rest and during the Allen test performance. During the Allen test performance, a direct positive correlation was obtained between the increase in the diameter of both, the radial and the ulnar artery, and their blood flow velocities; an increase in the cross-sectional area and in the blood flow rate was observed in both arteries when the other one was ocludded. Conclusions This dynamic blood flow study has evidenced a radial artery dominance of the hand. It has also demonstrated that there are some adaptive changes, both anatomical and functional, in both, the ulnar and the radial arteries, when there is an absence of the other one. This represents a dynamic system able to adapt to any present scenario.

We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. On the basis of an the Allen test preoperatively and the intraoperative findings, an adequate blood supply of the finger by the radial artery was expected. Thus, in respect to the patients wish, the aneurysm was resected without bridging. The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.