Percutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia

R. Ferraresi
2006 Circulation  
A 62-year-old man with insulin-dependent type II diabetes mellitus and chronic renal failure being treated with dialysis complained of chronic critical ischemia of the left hand with severe pain. A necrotic skin lesion with soft tissue infection and osteomyelitis of the distal part of the fourth finger was present ( Figure 1A) . A standard x-ray of the hand showed diffuse calcifications of the arteries ( Figure 1B and 1C ). An angiographic study was performed before therapeutic decisions were
more » ... de. Homolateral antegrade brachial approach with an 11-cm 4F introducer sheath was used. No brachial lesions were present; the ulnar artery was functionally occluded in the distal part, whereas a series of critical stenoses of the radial artery associated with diffuse disease of the vessels of the hand was documented ( Figure 1D) . A percutaneous transluminal approach was attempted. Hand amputation was considered the ultimate therapeutic option. After the intra arterial administration of 100 mg of lidocaine (for a better pain control), a 0.014-inch soft coronary guide wire was gently advanced through the radial artery until the deep palmar arch was reached. By using a 2.5-to 80-mm peripheral balloon (Amphirion Deep, Invatec Inc, Brescia, Italy), the lesions were dilated at high pressure (15 bar) (Figure 2A) . A good final angiographic result was obtained with immediate pain relief ( Figure 2B ). The patient was discharged the day after the procedure and 1 week later he underwent a planned surgical operation to remove the infected lesion of the finger by amputation. At an 8-month follow-up, the patient was asymptomatic and the surgical wound completely healed ( Figure 2C ). In conclusion, in selected cases, a percutaneous transluminal approach could be considered an effective option for the treatment of critical hand ischemia. A successful procedure can avoid a major amputation.
doi:10.1161/circulationaha.106.614008 pmid:16894041 fatcat:ql65qjzyvfc5fndwkindd3e4re