Acute Digital Ischaemia – What the Radiologist Needs to Know

Digital ischaemia is an uncommon pathology with multiple aetiologies, many of which are poorly understood. Imaging plays an important part in diagnosing curable causes. Digital substraction angiography (DSA) remains the gold standard for the study of the pathology of digital ischaemia. However, the improved spatial resolution and 3D image-processing tools of computed tomographic angiography (CTA) have led to its more recent application in the analysis of small and distal vessels. CTA is advantageous in that it provides both luminal and soft tissue imaging. It also yields a precise anatomical depiction of the vascularisation of the hand: the structure of the palmar arch is highly variable, an understanding of which is crucial when considering the source of blood supply to the arteries of the fingers. Here, we present a retrospective study of 32 patients with typical cases of the main aetiologies of digital ischaemia, all of whom underwent DSA. Eight patients suspected of hypothenar hammer syndrome additionally underwent CTA. In this study, we promote the use of CTA as a minimally invasive technique to clearly describe the localisation and extent of vessel injury.