Long-term Results of Ulnar and Radial Reconstruction With Interpositional Grafting Using the Deep Inferior Epigastric Artery for Chronic Hand Ischemia

Chronic hand ischemia causes cold intolerance, intractable pain, and digital ulceration. If ischemic symptoms persist despite pharmacologic treatments, surgical interventions should be considered. This retrospective study evaluated long-term results after ulnar and radial reconstruction using an interpositional deep inferior epigastric artery (DIEA) graft combined with periarterial sympathectomy. Patients who underwent this surgery from March 2003 to February 2019 were included. To evaluate variables influencing recurrence after the procedure, patients were divided into recurred and non-recurred groups and compared. Overall, 62 cases involving 47 patients were analyzed, with 16 and 46 cases in the recurred and non-recurred groups, respectively. The median length of DIEA grafts was 8.5 cm. Rates of rheumatic disease and female patients were significantly higher in the recurred group than in the non-recurred group, without significant between-group differences in postoperative complication rates. In the multivariate analysis, underlying rheumatic disease and graft length had significant effects on recurrence. In the Kaplan-Meier analysis, the 5- and 10-year symptom-free rates were 81.3% and 68.0%, respectively, with lower rates for cases with rheumatic disease. Thus, arterial reconstruction using an interpositional DIEA graft provides long-term sustainable vascular supply in chronic hand ischemia patients, especially those without rheumatic disease.