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

Honan, Kevin A.; Romero-Karam, Lily A; Mayes, Maureen D.; Arain, Salman A.

doi:10.1016/j.jaccas.2021.12.006

Cited by 2 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Introductionmentioning

confidence: 99%

“…We have recently shown that percutaneous transluminal angioplasty in the cardiac catheterization lab may be a viable treatment option for selected SSc patients with refractory ulceration. 5 Digital ischemia in SSc develops as a result of stenoses or occlusions affecting the distal vasculature of the forearm and the hand. The etiology of vessel occlusion includes a combination of vasospasm, intimal hypertrophy, and in situ thrombosis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis

Romero-Karam

Honan

Arain

et al. 2022

Journal of Scleroderma and Related Disorders

View full text Add to dashboard Cite

Objective: The objective of this study is to explore the role of adjunctive percutaneous revascularization of the hand in the management of patients with systemic sclerosis–associated refractory digital ischemia. Methods: We present our initial experience of using percutaneous upper extremity interventions to treat patients with systemic sclerosis and symptomatic Raynaud’s phenomenon who presented with either refractory digital ischemia or non-healing ulcers. We discuss patient characteristics, procedural findings, and short-term clinical outcomes of these interventions. Results: We performed 14 interventions in 6 patients with non-healing digital ulcers or refractory ischemia secondary to systemic sclerosis. Angioplasty was performed at or below the wrist in conjunction with intravenous prostaglandin therapy, started prior to or immediately after the revascularization procedure. All patients experienced symptomatic relief and demonstrated accelerated wound healing. Two patients required an additional procedure to treat recurrent ischemia (without new ulceration) in the treated digit. Three of the patients underwent multiple procedures during the study period to treat new ischemic lesions or Raynaud’s phenomenon symptoms, highlighting the progressive nature of the vascular occlusions in systemic sclerosis. There were no adverse events related to the interventions. Conclusions: Our retrospective analysis suggests that percutaneous revascularization in combination with vasodilator therapy in systemic sclerosis–associated digital ischemia is safe and can facilitate the healing of long-standing ulcers. Its role in the management of refractory digital ischemia in patients with systemic sclerosis should be explored further.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis

Romero-Karam

Honan

Arain

et al. 2022

Journal of Scleroderma and Related Disorders

View full text Add to dashboard Cite

show abstract

Digital ulcers associated with scleroderma: A major unmet medical need

Naik,

Stratton,

Leask

2024

Wound Repair Regeneration

View full text Add to dashboard Cite

Scleroderma or systemic sclerosis (SSc)‐associated digital ischaemic complications, such as digital ulcers (SSc‐DUs), appear relatively early during the disease course and are a major burden with substantial deterioration of quality of life. Expert rheumatologist and wound specialists have defined a DU; however, international application of the definition is still disorganised. Appearance of SSc‐DUs is secondary to the onset of Raynaud's phenomenon and as a consequence, recommended first‐line of treatment mainly includes vasodilators; however, many DUs are refractory to this treatment. Despite important practical issues, such as a lack of well‐characterised SSc‐wound healing animal model, significant efforts are needed to mechanistically understand the pathogenesis of SSc‐DUs for developing clinically targetable disease modifying therapies.

show abstract

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

Cited by 2 publications

References 7 publications

Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis

Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis

Digital ulcers associated with scleroderma: A major unmet medical need

Contact Info

Product

Resources

About