Outcomes of upper extremity interventions for chronic critical ischemia

Cheun, Tracy J.; Jayakumar, Lalithapriya; Sheehan, Maureen K.; Sideman, Matthew J.; Pounds, Lori L.

doi:10.1016/j.jvs.2018.04.056

Cited by 19 publications

(25 citation statements)

References 25 publications

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“…In the Cheun et al study, the status of the palmar arch prior to intervention was also predictive of wound healing, clinical success, cumulative patency, and freedom from MALE. 13 PTA of BTE vessels is safe. Two studies reported no complications, and the remaining studies reported predominately minor complications pertaining to access site hematoma or pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 91%

“…Cheun et al examined the outcomes of patients presenting with CHI due to BTE obstructive disease who underwent non-operative versus operative management (endovascular or surgical bypass). 13 Of 108 patients (average age = 59; 56% male), 34 underwent endovascular therapy with a median 1.5 vessels (UA, RA and/or IA) treated, 21 underwent a saphenous vein bypass to either the RA (12) and/or ulnar artery (11), and 53 were managed conservatively. At baseline, there was a higher proportion of patients with diabetes in the endovascular and surgical bypass groups compared with the no intervention group (94% and 81% vs 72%, p = 0.03).…”

Section: Conservative Management Endovascular Management or Surgical Bypassmentioning

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: 91%

Section: Conservative Management Endovascular Management or Surgical Bypassmentioning

confidence: 99%

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

et al. 2021

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“…For this reason, many patients do not undergo active management but only observation. To the best our knowledge, the only recent large series on outcomes of bypass surgery using the saphenous vein in below-the-elbow arterial atherosclerotic occlusive disease was reported by Cheun et al [22]. In their report, open intervention (bypass surgery) and endovascular intervention showed a high success rate and the incidence of major amputation was decreased.…”

Section: Discussionmentioning

confidence: 99%

Long-term Results of Ulnar and Radial Reconstruction With Interpositional Grafting Using the Deep Inferior Epigastric Artery for Chronic Hand Ischemia

Ahn

Yoon

et al. 2021

Preprint

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Chronic hand ischemia causes cold intolerance, intractable pain, and digital ulceration. If ischemic symptoms persist despite pharmacologic treatments, surgical interventions should be considered. This retrospective study evaluated long-term results after ulnar and radial reconstruction using an interpositional deep inferior epigastric artery (DIEA) graft combined with periarterial sympathectomy. Patients who underwent this surgery from March 2003 to February 2019 were included. To evaluate variables influencing recurrence after the procedure, patients were divided into recurred and non-recurred groups and compared. Overall, 62 cases involving 47 patients were analyzed, with 16 and 46 cases in the recurred and non-recurred groups, respectively. The median length of DIEA grafts was 8.5 cm. Rates of rheumatic disease and female patients were significantly higher in the recurred group than in the non-recurred group, without significant between-group differences in postoperative complication rates. In the multivariate analysis, underlying rheumatic disease and graft length had significant effects on recurrence. In the Kaplan-Meier analysis, the 5- and 10-year symptom-free rates were 81.3% and 68.0%, respectively, with lower rates for cases with rheumatic disease. Thus, arterial reconstruction using an interpositional DIEA graft provides long-term sustainable vascular supply in chronic hand ischemia patients, especially those without rheumatic disease.

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“…Conservative therapy can be applied to patients with significant comorbidities or minimal symptoms. Cheun et al [ 6 ] reported the results of conservative therapy in 53 (49%) patients among the 108 patients with symptomatic below-the-elbow atherosclerotic disease. The 3-month symptom relief rate was 31%, and the wound healing rate was 69%.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, no major amputation was performed in 30 days, which might be related to the abundant collateral circulation in the UE. However, conservative therapy in patients with no revascularization options resulted in lower wound healing and symptom relief rates than endovascular and bypass interventions [ 6 ]. Endovascular treatment for UE arterial occlusive disease is not popular because of the relative infrequency of interventions or the underlying causes of arterial disease.…”

Section: Discussionmentioning

confidence: 99%

In Situ Bypass from the Brachial to Radial Artery in the Anatomical Snuffbox for Limb Salvage in End-Stage Renal Disease

Hwang

Kim

2021

Vasc Specialist Int

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Diabetes and renal failure frequently involved in small vessel arteriopathy. With medical advancements, those patients survive longer with an increasing incidence of resultant arterial occlusive disease affecting the distal upper extremity (UE). In patients with ulcers or gangrene in the distal UE, bypass surgery is often complicated by severe atherosclerosis with calcification, resulting in poor distal anastomosis quality. Here we report a patient with a fingertip gangrene who were successfully treated with in situ bypass from the brachial artery below the elbow to the radial artery in the anatomical snuffbox under local anesthesia. Bypass graft patency was maintained during the 18-month follow-up. If the forearm cephalic vein and radial artery in the anatomical snuffbox are of adequate quality, in situ bypass to radial artery in the anatomical snuffbox may be a useful option for limb salvage in selected patients.

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Outcomes of upper extremity interventions for chronic critical ischemia

Abstract: Upper extremity interventions for critical ischemia are associated with a high rate of success. Major amputations are rare and the many can be treated nonoperatively. In appropriately selected patients, both endovascular and open interventions have a high rate of success.

Cited by 19 publications

References 25 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

Long-term Results of Ulnar and Radial Reconstruction With Interpositional Grafting Using the Deep Inferior Epigastric Artery for Chronic Hand Ischemia

In Situ Bypass from the Brachial to Radial Artery in the Anatomical Snuffbox for Limb Salvage in End-Stage Renal Disease

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