Digital ischaemia in a renal transplant patient

A renal transplant patient presented with a sudden onset of painful left index finger (Figure 1). He had a palpable left radial pulse with an absent ulnar pulse. The left index finger was cold and dusky with reduced capillary refill and sensation. There were multiple splinter haemorrhages visible in the left hand only (Figure 2). He had a non-functional arteriovenous fistula (AVF) at the left wrist (Figure 3). Initially he was treated with intravenous heparin and analgesia followed by an arteriogram, which showed an aneurysm of the left radial artery, poor ulnar and interosseous arterial flow and occluded index finger