LAUSR

A 65yearold man from a rural town presented with severe lefthand pain on a background of previously diagnosed Buerger disease. He described arm and hand claudication over 30 years and a smoking history of 80 packyears. On examination, multiple small digital ulcers were identified (Figure, A). Catheter arteriogram (Figure, B) showed occlusion of the distal ulnar artery (red arrow), radial artery (blue arrow) and interosseous artery (red arrowhead), with collateral “corkscrew” vessels (blue arrowhead).