Critical hand ischemia treatment via orbital atherectomy—A single center observational retrospective analysis

Bahro, Abdul; Igyarto, Zsuzsanna; Martinsen, Brad J.

doi:10.1016/j.carrev.2016.10.009

Cited by 3 publications

(11 citation statements)

References 21 publications

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“…28 Atherectomy has been described for BTE arterial occlusive disease, but due to limited available evidence to date, no definitive conclusions can be drawn. 6 There was a high technical success rate across all studies ranging from 82% to 100% (weighted average was 89.3%), demonstrating that PTA is feasible and can reliably establish inline flow to the palmar arch. The restenosis rate varied from 18% to 44% at 6-48 months follow-up in 4 studies.…”

Section: Discussionmentioning

confidence: 80%

“…4,5 There is usually a diffuse involvement of the BTE vessels, including the ulnar artery, radial artery, palmar arch, and digital vessels, with seldom isolated involvement of the interosseous artery. [4][5][6][7][8][9][10] Distal calcific arteriosclerosis plays a pivotal role in the pathophysiology of hand ischemia, particularly in hemodialysis patients. 5 Currently, there is no consensus algorithm regarding the most appropriate revascularization strategy for patients with CHI due to BTE vessel disease.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

et al. 2021

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Purpose: To perform a systematic review assessing the safety and efficacy of percutaneous transluminal angioplasty (PTA) for treatment of critical hand ischemia (CHI) due to below-the-elbow (BTE) obstructive arterial disease. Materials and Methods: MEDLINE and EMBASE systematic searches were performed from inception to December 2020 to identify studies assessing PTA for management of BTE obstructive arterial disease. Three independent reviewers performed abstract selection, data extraction, and quality assessment. The Newcastle-Ottawa Scale was used to assess individual study bias for non-randomized controlled trials. Results: Eight studies comprising 176 patients with obstructive BTE vessel disease were included. All studies had a score >5 on the Newcastle-Ottawa Scale, indicative of high quality. All studies used low-profile balloons (1.5–4 mm) for PTA of stenotic lesions or chronic total occlusions (CTOs). The weighted average technical success and clinical success rates were 89.3% (range = 82%–100%) and 69.9% (range = 19%–100%), respectively, at a mean follow-up of 29.7 ± 17.1 months. The short-term (<30 days) complication rate was low at 4.7% and most commonly included access site hematomas, pseudoaneurysms, and radial artery perforation or re-thrombosis. Nearly 20% of patients required an amputation, and most (96%) were minor (either distal phalanges or digits). Only 2 patients required above-wrist amputations. The primary and secondary patency rate at 5 years were 38% and 54%, respectively. The cumulative 5-year mortality rate was 33.1%. Conclusions: PTA for CHI due to BTE obstructive arterial disease is feasible with a high technical success rate and a low short-term complication rate. Additional long-term comparative studies are required to unequivocally establish the clinical benefit of endovascular treatment compared with conservative management or surgical bypass.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

et al. 2021

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“…6 As more endovascular experience is gained for BTE disease, the role of advanced revascularization techniques and tools is expected to expand, similar to the evolution of below-knee endovascular revascularization strategies. Bahro et al 8 evaluated 11 patients with 11 heavily calcified forearm arteries that were pretreated with orbital atherectomy prior to angioplasty, achieving 100% technical and 30-day clinical success for wound healing and freedom from repeat revascularization or amputation. The results highlighted the potential value of atherectomy in this arterial system, in which long segment calcifications are common.…”

Section: Discussionmentioning

confidence: 99%

“…With advancements in endovascular technology and expertise from below-knee revascularization, endovascular approaches to occlusive disease of the BTE arteries have become a viable option for these patients. Experience with these strategies have been described in case reports and case series, 2,[7][8][9][10][11][12][13] but published outcomes are sparse compared with that for lower extremity disease. Notably, endovascular revascularization is not part of current surgical management algorithms for CHI.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience

et al. 2019

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Purpose: To evaluate the technical success, clinical success, and complication rates of endovascular revascularization for below-the-elbow (BTE) peripheral artery disease. Materials and Methods: A retrospective review was performed of 19 patients (mean age 63 years; 12 men) with critical hand ischemia (CHI) who underwent 25 interventions in 19 arms between October 2010 and June 2017. Access was attained using 4-F or 5-F sheaths via antegrade brachial, retrograde radial, or fistula/graft access routes depending on the target vessel. A 0.018-inch hydrophilic microwire was used for intimal or subintimal recanalization. Angioplasty was performed over a 0.014-inch guidewire using low-profile balloons. The primary endpoint of the study was technical success, defined as successful lesion crossing/dilation, with residual stenosis <30%. Clinical success referred to improvement in pain and/or steal symptoms. Results: Technical success was achieved in 88% (22 of 25 procedures), with no significant difference in outcome associated with indications or baseline vessel disease. Complications occurred in 6 cases, of which 5 were minor and 1 was major. Clinical success was achieved in 12 of 14 patients with available follow-up; 5 of 7 patients with ulcers experienced wound healing. Conclusion: Endovascular revascularization for BTE occlusive disease is an effective and safe strategy for treating CHI.

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Treatment of critical hand ischemia via orbital atherectomy and focal force balloon angioplasty: A mini-review

Bahro¹,

Igyarto

Williams³

et al. 2019

Cardiovascular Revascularization Medicine

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Critical hand ischemia treatment via orbital atherectomy—A single center observational retrospective analysis

Cited by 3 publications

References 21 publications

Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience

Treatment of critical hand ischemia via orbital atherectomy and focal force balloon angioplasty: A mini-review

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