Novel strategy for percutaneous transluminal angioplasty for complex critical hand
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CASE REPORT
Novel strategy for percutaneous transluminal angioplasty for complex critical hand Hideki Itaya • Masato Nakamura
Received: 27 January 2011 / Accepted: 25 August 2011 / Published online: 27 September 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract A 60-year-old patient with end-stage renal disease was referred to our institute with ischemic tissue loss and pain at rest of the fourth finger of the left hand. Lesions involved the subclavian artery, the brachial artery, the ulnar artery, the radial artery and the palmer arch. After successful angioplasty with noble technique, patient’s symptoms were disappeared immediately and ischemic lesions were healed at only 1-month follow-up. This interesting case report may illustrate a help of treatment strategy of critical hand ischemia with complex lesions. Keywords Critical hand ischemia Percutaneous transluminal angioplasty ESRD
Introduction Recently, manifestations of severe atherosclerosis which go beyond our experience, have occurred. Critical hand ischemia (CHI) is one such instance, although atherosclerotic obstructive disease of the upper extremities is less common than those of the lower extremities. Patients with end-stage renal disease (ESRD) are at risk of CHI, which can be precipitated by a steal phenomenon associated with preexisting or postsurgical obstructive disease [1]. Considering the increasing number of ESRD patients worldwide, CHI is an emerging problem that needs to be recognized. To date, although some cases have been reported, they are limited to relatively simple lesion cases. Here, we present the case of a patient who had complex
H. Itaya (&) M. Nakamura Toho University Ohashi Medical Center, Tokyo, Japan e-mail: [email protected]
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lesions and who was successfully treated by percutaneous transluminal angioplasty with a novel technique.
Case report A 60-year-old patient with ESRD was referred to our hospital with pain of the fingers at rest and digital ulceration of the fourth finger of the left hand (Fig. 1). The patient was affected by multiple comorbidities (angina pectoris—post coronary artery bypass grafting, peripheral artery disease—post amputation of both legs) but he had no history of previous left forearm-wrist trauma and/or surgery. He has his haemodialysis access vessel in his right hand. He had injured his left finger while operating his wheelchair and had already received disinfectant treatment for over 3 months but the wound had not healed. Physical examination showed necrotic tissue on the side of the fourth digit with no pulse below the elbow. A computed tomography (CT) angiogram showed no stenosis at the bifurcation of the aorta and the left subclavian artery (Fig. 2a); however stenosis was seen at the mid portion of the left subclavian artery (Fig. 2b) and the left brachial artery (Fig. 3a). The ulnar and radial arteries had severe and long stenosis (Fig. 3b). Baseline angiogram, via a right femoral approach (5Fr catheter, 10 cm long introducer sheath, Te
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