Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience. (August 2019)

• Record Type: Journal Article
• Authors: Chen, James X.; Levin, L. Scott; Mantell, Mark P.; Redmond, Jonas W.; Clark, Timothy W. I.
• Is Part Of: Journal of endovascular therapy. Volume 26:Number 4(2019:Aug.)
• Page Start: 505
• Page End: 511
• Publication Date: 2019-08
• Subjects: angioplasty -- arteriovenous fistula -- forearm artery -- critical hand ischemia -- radial artery -- occlusion -- palmer artery -- steal syndrome -- stenosis -- ulnar artery -- wound healing; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1177/1526602819854167
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: To evaluate the technical success, clinical success, and complication rates of endovascular revascularization for below-the-elbow (BTE) peripheral artery disease.Materials and Methods: A retrospective review was performed of 19 patients (mean age 63 years; 12 men) with critical hand ischemia (CHI) who underwent 25 interventions in 19 arms between October 2010 and June 2017. Access was attained using 4-F or 5-F sheaths via antegrade brachial, retrograde radial, or fistula/graft access routes depending on the target vessel. A 0.018-inch hydrophilic microwire was used for intimal or subintimal recanalization. Angioplasty was performed over a 0.014-inch guidewire using low-profile balloons. The primary endpoint of the study was technical success, defined as successful lesion crossing/dilation, with residual stenosis <30%. Clinical success referred to improvement in pain and/or steal symptoms.Results: Technical success was achieved in 88% (22 of 25 procedures), with no significant difference in outcome associated with indications or baseline vessel disease. Complications occurred in 6 cases, of which 5 were minor and 1 was major. Clinical success was achieved in 12 of 14 patients with available follow-up; 5 of 7 patients with ulcers experienced wound healing.Conclusion: Endovascular revascularization for BTE occlusive disease is an effective and safe strategy for treating CHI.