Percutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia
2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 6 Linguagem: Inglês
10.1161/circulationaha.106.614008
ISSN1524-4539
AutoresRoberto Ferraresi, Marco Ferlini, Fabiola B. Sozzi, G. Pomidossi, C. Caravaggi, Gian Battista Danzi,
Tópico(s)Peripheral Nerve Disorders
ResumoHomeCirculationVol. 114, No. 6Percutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBPercutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia Roberto Ferraresi, MD, Marco Ferlini, MD, Fabiola Sozzi, MD, PhD, Guido Pomidossi, MD, Carlo Caravaggi, MD and Gian B. Danzi, MD Roberto FerraresiRoberto Ferraresi From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. , Marco FerliniMarco Ferlini From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. , Fabiola SozziFabiola Sozzi From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. , Guido PomidossiGuido Pomidossi From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. , Carlo CaravaggiCarlo Caravaggi From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. and Gian B. DanziGian B. Danzi From the Interventional Cardiology Department, Ospedale Maggiore Policlinico IRCCS, Milan, Italy. Originally published8 Aug 2006https://doi.org/10.1161/CIRCULATIONAHA.106.614008Circulation. 2006;114:e232–e234A 62-year-old man with insulin-dependent type II diabetes mellitus and chronic renal failure being treated with dialysis complained of chronic critical ischemia of the left hand with severe pain. A necrotic skin lesion with soft tissue infection and osteomyelitis of the distal part of the fourth finger was present (Figure 1A). A standard x-ray of the hand showed diffuse calcifications of the arteries (Figure 1B and 1C). An angiographic study was performed before therapeutic decisions were made. Homolateral antegrade brachial approach with an 11-cm 4F introducer sheath was used. No brachial lesions were present; the ulnar artery was functionally occluded in the distal part, whereas a series of critical stenoses of the radial artery associated with diffuse disease of the vessels of the hand was documented (Figure 1D). A percutaneous transluminal approach was attempted. Hand amputation was considered the ultimate therapeutic option. After the intra arterial administration of 100 mg of lidocaine (for a better pain control), a 0.014-inch soft coronary guide wire was gently advanced through the radial artery until the deep palmar arch was reached. By using a 2.5- to 80-mm peripheral balloon (Amphirion Deep, Invatec Inc, Brescia, Italy), the lesions were dilated at high pressure (15 bar) (Figure 2A). A good final angiographic result was obtained with immediate pain relief (Figure 2B). The patient was discharged the day after the procedure and 1 week later he underwent a planned surgical operation to remove the infected lesion of the finger by amputation. At an 8-month follow-up, the patient was asymptomatic and the surgical wound completely healed (Figure 2C). Download figureDownload PowerPointFigure 1. A, Critical ischemia of the left hand with a necrotic skin lesion on the distal part of the fourth finger. B, Standard x-ray of the hand (dorsal view) showing severe and diffuse calcification of metacarpal and digital arteries (arrows). C, Standard x-ray of the wrist showing heavy calcification of the ulnar (arrow) and radial arteries (asterisks). D, Baseline angiography illustrating diffuse disease of the forearm and hand arteries. There is total occlusion of the distal ulnar artery (arrow) and a series of critical lesions of the radial artery (arrows).Download figureDownload PowerPointFigure 2. A, High-pressure inflation of the long balloon positioned in the radial artery up to the proximal part of the deep palmar arch. B, Final angiographic result with recanalization of the radial artery and deep palmar arch. C, Patient's hand at 8-month follow-up. Complete healing of the surgical wound at the site of the amputation of the fourth finger is shown.In conclusion, in selected cases, a percutaneous transluminal approach could be considered an effective option for the treatment of critical hand ischemia. A successful procedure can avoid a major amputation.DisclosuresNone.FootnotesCorrespondence to Gian B. Danzi, MD, Division of Cardiology, Pad. Sacco, Ospedale Maggiore Policlinico, Via F. Sforza, 35, 20122 Milan, Italy. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Awad El-Karim G, Kennedy S, Ferraresi R, Addas J, Oreopoulos G, Jaberi A, Tan K and Mafeld S (2021) Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review, Journal of Endovascular Therapy, 10.1177/15266028211050309, 29:3, (468-477), Online publication date: 1-Jun-2022. Morosetti D, D'Onofrio A, Argirò R, Di Martino A, Vidali S, Nezzo M, Wlderk A, Da Ros V and Gandini R (2020) Endovascular Treatment of Critical Hand Ischemia: A Single-Center Experience, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2020.04.017, 21:11, (1438-1443), Online publication date: 1-Nov-2020. Bahro A, Igyarto Z, Williams C, Abraham J and Martinsen B (2019) Treatment of critical hand ischemia via orbital atherectomy and focal force balloon angioplasty: A mini-review, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2018.03.012, 20:3, (248-253), Online publication date: 1-Mar-2019. Bahro A, Igyarto Z and Martinsen B (2017) Critical hand ischemia treatment via orbital atherectomy—A single center observational retrospective analysis, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2016.10.009, 18:2, (91-94), Online publication date: 1-Mar-2017. Tomoi Y, Soga Y, Fujihara M, Iida O, Shintani Y, Zen K and Ando K (2016) Outcomes of Endovascular Therapy for Upper Extremity Peripheral Artery Disease With Critical Hand Ischemia, Journal of Endovascular Therapy, 10.1177/1526602816659279, 23:5, (717-722), Online publication date: 1-Oct-2016. Ferraresi R (2015) The Ischemic Hand of Mr. M, Nephrology @ Point of Care, 10.5301/napoc.2015.14612, 1:1, (napoc.2015.1461), Online publication date: 1-Jan-2015. Kawarada O, Sakamoto S, Harada K, Noguchi T, Ogawa H and Yasuda S (2014) Below-the-elbow intervention for Buerger's disease, Cardiovascular Intervention and Therapeutics, 10.1007/s12928-014-0312-2, 30:4, (385-389), Online publication date: 1-Oct-2015. Nasser F, Cavalcante R, Galastri F, de Amorim J, Telles M, Travassos F, Fina B and Affonso B (2014) Endovascular Stenting of Brachial Artery Occlusion in Critical Hand Ischemia, Annals of Vascular Surgery, 10.1016/j.avsg.2013.12.022, 28:6, (1564.e1-1564.e3), Online publication date: 1-Aug-2014. Ferraresi R and Palloshi A (2013) Below the Elbow Occlusive Disease Handbook of Endovascular Interventions, 10.1007/978-1-4614-5013-9_13, (163-174), . Ferraresi R, Palloshi A, Aprigliano G, Caravaggi C, Centola M, Sozzi F, Danzi G and Manzi M (2012) Angioplasty of Below-the-elbow Arteries in Critical Hand Ischaemia, European Journal of Vascular and Endovascular Surgery, 10.1016/j.ejvs.2011.10.006, 43:1, (73-80), Online publication date: 1-Jan-2012. Kawarada O, Yokoi Y and Higashimori A (2010) Angioplasty of ulnar or radial arteries to treat critical hand ischemia: Use of 3- and 4-French Systems, Catheterization and Cardiovascular Interventions, 10.1002/ccd.22545, 76:3, (345-350), Online publication date: 1-Sep-2010. Ruzsa Z, Pintér L and Kolvenbach R (2010) Anterograde recanalisation of the radial artery followed by transradial angioplasty, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2010.01.007, 11:4, (266.e1-266.e4), Online publication date: 1-Oct-2010. Benedetto F, Lentini S, Pipito N, De Caridi G, Stilo F and Spinelli F (2010) Endovascular Options in Failing Upper Limb Bypass Surgery, The American Surgeon, 10.1177/000313481007601205, 76:12, (230-232), Online publication date: 1-Dec-2010. Spinelli F, Benedetto F, Passari G, La Spada M, Carella G, Stilo F, De Caridi G and Lentini S (2010) Bypass Surgery for the Treatment of Upper Limb Chronic Ischaemia, European Journal of Vascular and Endovascular Surgery, 10.1016/j.ejvs.2009.10.015, 39:2, (165-170), Online publication date: 1-Feb-2010. Hendrickson M (2010) Chronic Arterial Ischemia of the Upper Extremity: Diagnosis, Evaluation, and Surgical Management Plastic and Reconstructive Surgery, 10.1007/978-1-84882-513-0_40, (573-581), . Cremonesi A, de Campos Martins E, Liso A, Gieowarsingh S and Castriota F (2009) Percutaneous Angioplasty of the Radial Artery and its Deep Palmar Branch for Critical Hand Ischemia – A Case Report, EJVES Extra, 10.1016/j.ejvsextra.2009.01.003, 17:5, (51-53), Online publication date: 1-May-2009. August 8, 2006Vol 114, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.614008PMID: 16894041 Originally publishedAugust 8, 2006 PDF download Advertisement SubjectsAngiographyDiabetes, Type 2Peripheral Vascular Disease
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