Ischemic changes of the digits caused by emboli are rare. When they do
occur, the typical sites of origin include the heart, the proximal su
bclavian artery, and the thoracic outlet. Dialysis access or iatrogeni
c injuries may be a more distal source of emboli. Two patients, each w
ith embolization to the thumb and index finger from a lesion in the an
atomical snuff-box, were studied. Neither patient had any other athero
sclerotic occlusive disease, and both lesions occurred precisely where
the extensor pollicis longus crossed the artery and would be expected
to compress it against the proximal epiphysis of the first metacarpal
when the hand was closed. These lesions were excised, and bypass was
performed, with rapid resolution of symptoms. This is an unusual cause
of digital embolization that should be considered in patients with em
boli to the thumb and index finger.