Hypothenar Hammer Syndrome: Management of Acute Thromboembolic Complications From an Ulnar Artery Aneurysm.

Hypothenar hammer syndrome is a rare vascular disorder resulting from repetitive trauma to the hypothenar region of the hand, leading to ulnar artery injury and potential aneurysm formation. The aneurysm can eventually release distal emboli and lead to acute digital ischemia. Hypothenar hammer syndrome is often underdiagnosed, particularly in the plastic surgery setting. Management strategies are not standardized, and literature offering detailed surgical techniques, particularly involving palmar arch aneurysms, is sparse. We present the case of a 63-year-old manual laborer with a known ulnar artery aneurysm responsible for recurrent episodes of transient digital ischemia. The condition was initially managed conservatively; however, due to a worsening of symptoms, an elective surgical intervention was scheduled. Three months before the planned procedure, the patient presented to the emergency department with persistent acute ischemia of the third, fourth, and fifth fingers of the left hand. The imaging confirmed complete occlusion of the ulnar artery at the level of the aneurysm. Emergency intervention included aneurysm resection, ulnar artery anastomosis, and thromboembolectomy of the digital arteries. Multiple revascularization techniques were used, including intra-arterial heparinization, thrombolysis with urokinase, and Fogarty catheterization via different surgical approaches to the superficial palmar arch and digital arteries. Revascularization was successfully achieved in the ischemic digits. At the 2-year follow-up, the patient showed no recurrence and no sequelae. This case underscores the risks associated with delayed treatment of large digital aneurysms (>2 cm), called for prompt intervention upon diagnosis, and highlighted surgical tips that may improve outcomes in cases of embolic complications.