of Below-the-elbow Arteries in Critical Hand Ischaemia

Upper Extremity Ischemia/Dialysis Access


Angioplasty of Below-the-elbow Arteries in Critical Hand Ischaemia


Ferraresi R, Palloshi A, Aprigliano G, et al (Istituto Clinico Città Studi, Milan, Italy; et al) Eur J Vasc Endovasc Surg 43:73–80, 2012§



G.L. Moneta, MD



Evidence Ranking


• C



Expert Rating


• 1



Abstract



Background


Critical hand ischaemia (CHI) due to pure below-the-elbow (BTE) artery obstruction is a disabling disease and there is still no consensus concerning the most appropriate revascularisation strategy. The aim of this study was to assess the feasibility, safety and outcomes of percutaneous transluminal angioplasty (PTA) in the treatment of CHI due to pure BTE artery disease.



Methods and Results


Twenty-eight patients (age 62 ± 11 years; three females) with a total of 34 hands affected by CHI (one pain at rest; 18 non-healing ulcer; 15 gangrene) due to pure BTE artery disease underwent PTA. Most of the patients were males with a long history of diabetes mellitus, end-stage renal disease (ESRD) on haemodialysis and systemic atherosclerosis. The interosseous artery was free of disease in all cases, whereas the radial and ulnar arteries were simultaneously involved in 31/34 hands with long stenosis/occlusions (91%; mean length 155 ± 64 mm). The technical success rate was 82% (28/34), with only three minor complications. In the three cases with a functioning radial arteriovenous fistula, we successfully treated the ulnar artery. PTA was unsuccessful in 18% (6/34) hands due to inability to cross severely calcified lesions. The hand-healing rate was 65% (22/34). The predictors of hand healing were PTA technical success (odds ratio (OR) 0.5, confidence interval (CI) 0.28–0.88; p ≤ 0.0001) and digital run-off (OR 0.37, CI 0.19–0.71; p ≤ 0.003).


The mean follow-up period was 13 ± 9 months. Six patients (18%) underwent secondary procedures due to symptomatic restenosis. In all these cases, a successful re-PTA was performed at a mean 6 months after the index procedure, and there were no major procedure-related events. Ten patients (36%) died during follow-up.

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on of Below-the-elbow Arteries in Critical Hand Ischaemia

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