103 - Endovascular Intervention of Critical Limb-Threatening Ischemia of the Upper Extremity With Gangrene: A Case Study
Adrianne Valles, MBA – Clinical Specialist, RestoreME Wound Care Solutions
Purpose: Limb preservation through endovascular intervention of the right upper extremity with critical limb-threatening ischemia, Rutherford class VI with gangrene to the fingers.
Material and Methods: Peripheral interventional procedure performed, a 4-FR JR4 catheter was advanced through the femoral sheath into the subclavian artery then advanced into the brachial artery. Next the JR4 was exchanged with a 6-FR multipurpose guide advancing into the brachial artery. Angiogram of the right upper extremity was performed, it showed right brachial artery was patent distally and the large ulnar artery was total occluded proximal to the wrist. The radial artery was completely occluded and not visible. The patient's only blood supply comes from one single collateral artery to the palmar arch. There is reconstitution of the ulnar artery in the middle portion of the palm. Next, 0.14 angled TrailBlazer along with 0.014 Advantage wire was advanced into the occlusion of the ulner artery, but unable to go through it. Under ultrasound access was obtained at the reconstituted ulnar artery in the palm, a 0.18 wire was advanced successfully retrogradely crossing the occluded ulnar artery; continuing up to the reconstituted ulnar artery. Then through this access PTA was performed with a coronary balloon, but was unable to get antegrade wire following tract. A snare was advanced through the micro puncture sheath from the hand and the antegrade wire was snared and brought into the palmar sheath. Then the wire was advanced through the palmar sheath and removed. The antegrade wire was advanced down into the digital branches and a balloon was advanced crossing all the occlusion and puncture site; and inflated for 15 then 10 minutes.
Results: There was recanalization of the ulnar artery with extensive great flow to the digits. No evidence of further bleeding or perforation. The patient is free of pain and discomfort immediately after the procedure.
Conclusions: Critical limb-threatening ischemia of the upper extremity although less common than lower extremity ischemia it is just as threatening and deadly. The endovascular approach has many offerings and challenges to revascularization. With the cases in upper extremity critical limb ischemia rising the new and novel techniques and devices in these procedures are imperative in saving both upper and lower extremities and saving lives.