Endovascular management of critical hand ischemia by 'palmar arch loop' technique
Endovascular management of critical hand ischemia by 'palmar arch loop' technique
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DOI：
10.1177/1708538120966939
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发表时间：
2020-10-21
期刊：
影响因子：
1.1
通讯作者：
Krishna, Vinay
中科院分区：
文献类型：
--
作者：
Singh, Amit;Kumar, Neeraj;Krishna, Vinay
严重的手部缺血伴进行性手指坏疽需要紧急干预以尽可能多地挽救组织。本研究的目的是评价“掌弓环”技术在血管内治疗严重手部缺血的有效性，方法是在顺行再通失败的患者中通过桡动脉和尺动脉建立掌弓的内联血流。据我们所知，这是第一个病例系列评估的有效性“掌弓环”技术，与逆行经皮腔内血管成形术的参与桡动脉和/或尺动脉。材料和方法我们回顾性研究了10例患者（60%女性;平均年龄42 +/- 18岁;急性事件后出现严重手部缺血的平均时间（24 ± 11天），使用“掌弓环”进行血管内介入治疗2017年4月至2019年3月期间，在印度北方的一个中心进行了技术研究。所有患者均定期接受随访（每周一次，持续一个月，每两周一次，持续3个月，然后在6个月和12个月时），进行临床评估和SpO（2）测量。研究终点是技术成功率，手愈合，并在一年的主要通畅率。ResultsCauses for critical hand ischemia是医源性损伤，由于无意中动脉内注射在50%（n = 5）和血栓栓塞事件在50%的患者（n = 5）。涉及的血管包括：桡、尺动脉同时沿着走行者占50%，桡动脉与掌弓同时走行者占30%，尺动脉与掌弓同时走行者占20%。所有患者的受累血管均完全闭塞（>总长度的2/3），同时伴有掌弓闭塞/弥漫性疾病;技术成功率为70%，确保经两条动脉流入掌弓，改善了远端至总动脉和固有动脉的血流。50%（n = 5）桡动脉和20%（n = 2）尺动脉的逆行经皮腔内血管成形术通过将导丝绕环穿过掌弓成功完成; 90%显示疼痛主观改善，病变愈合和/或形成清晰的分界线，近端坏疽前变化逆转。8例手指坏疽患者中，3例接受坏疽手指小截肢术，5例接受坏疽组织自体截肢术，残端完全愈合。1年时一期通畅率为85.7%。有没有访问网站相关的并发症或死亡率在随访period.ConclusionsEndovascular管理的关键手缺血的“掌弓环”技术是一种有效的技术来处理闭塞的前臂血管，特别是当顺行再通失败。该技术具有良好的技术成功率和通畅率，可能是血管内器械中用于挽救手部的独特工具。
IntroductionCritical hand ischemia with advancing gangrene of digits requires urgent intervention to salvage as much tissue as possible. The purpose of this study was to evaluate the efficacy of "palmar arch loop" technique for endovascular management of critical hand ischemia by establishing inline flow to the palmar arch via both radial artery and ulnar artery, in patients with failed antegrade recanalization. To the best of our knowledge, this is the first case series evaluating the efficacy of "palmar arch loop" technique, with retrograde percutaneous transluminal angioplasty of the involved radial artery and/or ulnar artery.Material and methodsWe retrospectively investigated 10 patients (60% female; mean age 42 +/- 18 years; mean time of presentation post-acute event 24 +/- 11 days) with critical hand ischemia undergoing endovascular intervention using "palmar arch loop" technique at a single center in northern India between April 2017 and March 2019. All patients were followed up at regular intervals (weekly for a month, fortnightly for 3 months, and then at 6 and 12 months) with clinical assessment and SpO(2) measurement. Study end points were technical success rate, hand healing, and primary patency rate at one year.ResultsCauses for critical hand ischemia were iatrogenic injuries due to inadvertent intra-arterial injection in 50% (n = 5) and thromboembolic events in 50% patients (n = 5). Vessels involved were: both radial artery and ulnar artery along with the PA in 50%; radial artery and palmar arch in 30%; ulnar artery and palmar arch in 20%. All of them had total occlusion of the involved vessel (>2/3rd of total length) with occlusion/diffuse disease of palmar arch as well; 70% technical success rate was achieved ensuring inflow to palmar arch via both the arteries with improved flow distally to the common and proper digital arteries. Retrograde percutaneous transluminal angioplasty of radial artery in 50% (n = 5) and ulnar artery in 20% (n = 2) was done successfully by looping the guidewire across the palmar arch; 90% showed subjective improvement in pain with healing of the lesions and/or formation of clear line of demarcation with reversal of pregangrenous changes proximally. Out of the eight patients with gangrene of fingers, three underwent minor amputation of the gangrenous digits and five underwent auto-amputation of the gangrenous tissue with complete healing of the stump. Primary patency rate was 85.7% at one year. There was no access site-related complication or mortality in the follow-up period.ConclusionsEndovascular management of critical hand ischemia by "palmar arch loop" technique is an efficient technique to deal with occluded forearm vessels, particularly when antegrade recanalization fails. This technique, with good technical success and patency rates, is potentially a unique tool in the endovascular armamentarium for salvaging hand.