Short‐ and long‐term results with a percutaneous treatment in critical hand ischaemia

Abstract

Background The aim of this prospective registry was to determine the feasibility, safety, and outcomes of percutaneous transluminal angioplasty and thrombolysis in the treatment of critical hand ischemia (CHI). Methods One‐hundred one patients (aged 60.6 ± 15.3 years) were treated for CHI between 2012 and 2016 in three cardiovascular centers. Anatomically, the upper arm was divided into three segments (I‐subclavian, II‐brachial, and III‐forearm). We examined the rates of technical and clinical success, major adverse events (MAEs), and vascular complications at 1 year and at long‐term follow‐up. Results Nineteen patients (18.8%) were treated for acute CHI, and 82 (81.2%) for chronic CHI. Median follow‐up was 36.9 (19.6–68.3) months. Clinical symptoms were isolated rest pain in 91 patients (90.1%) and digital ulcer or gangrene in 10 patients (9.9%). The technical and clinical success rate of intervention was 96.0% (97/101) and 84.2% (85/101) at 1 year. Angioplasty was performed in Segments I, II, and III in 28 (27.7%), in 29 (28.7%), and 44 (43.5%) patients. Stent implantation was necessary in 47 patients (46.8%). Vascular access site complications were found in 2.1% of the sample. After 1 year, MAEs occurred in 27 patients (26.9%), and the target lesion revascularization rate was 11.9%. In two patients (1.9%), thoracic sympatectomy was necessary, and two patients (1.9%) underwent minor finger amputations. Conclusions Angioplasty of hand vessels for CHI is a feasible and safe procedure with acceptable rates of technical success and hand healing. MAEs are frequent because the rate of severe comorbidities is high.

Total Percutaneous Revascularization of the Hand to Treat Refractory Digital Ischemia in Advanced Systemic Sclerosis

“…Percutaneous revascularization is commonly performed for limb salvage in lower extremity atherosclerotic disease and has been shown to be safe in small cohorts of patients with other forms of critical limb ischemia (CLI). 6 , 7 Patients with lower extremity CLI of any cause often present with chronic occlusion of small-caliber (≤3-mm diameter) arteries, which can be successfully revascularized using contemporary endovascular techniques in most cases. We hypothesized that this approach could be used to treat refractory upper extremity digital ischemia in our patient.…”

Successful Endovascular Therapy for Total Occlusion of the Distal Radial and Ulnar Artery with Palmar Artery Lesion in a Patient with Critical Hand Ischemia Associated with Systemic Sclerosis

“…This report describes a rare case of technically and clinically successful revascularization in a BTE lesion with total occlusion from the distal RA and UA to the palmar artery in a patient with SSc. Endovascular therapy for BTE lesions in patients with CHI associated with atherosclerosis has been reported as a feasible treatment option for revascularization 5-8 ; therefore, endovascular intervention for BTE lesions in patients with CHI associated with SSc might be considered as a treatment option. An antegrade approach should be attempted first in BTE interventions, but a retrograde approach via the palmar arch may be useful as an alternative if this attempt fails.…”

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

“…Complications and limb loss data are presented in Table 4 13 Although the Ruzsa et al study reported 42/101 cumulative major adverse event rate at 3 years, the data includes outcomes for both ATE and BTE revascularization. 9 Nearly 20% of patients required an amputation, and most (96%) were minor (either distal phalanges or digits). Only 2 patients required above-wrist amputations.…”

“… 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 - 10 Distal calcific arteriosclerosis plays a pivotal role in the pathophysiology of hand ischemia, particularly in hemodialysis patients. 5…”

“… 12 , 13 In the last 2 decades, several studies have shown promising results with percutaneous transluminal angioplasty (PTA) of BTE arteries for the management of CHI. 3 , 4 , 6 - 10 , 13 This systematic review aims to assess the feasibility, technical success, long-term outcomes, and complications of PTA for the treatment of CHI due to BTE arterial disease.…”