Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience

• Published in: Journal of endovascular therapy Vol. 26; no. 4; p. 505
• Main Authors: Chen, James X, Levin, L Scott, Mantell, Mark P, Redmond, Jonas W, Clark, Timothy W I
• Format: Journal Article
• Language: English
• Published: United States 01.08.2019
• Subjects: critical hand ischemia; forearm artery; wound healing; occlusion; palmer artery; ulnar artery; arteriovenous fistula; stenosis; radial artery; angioplasty; steal syndrome
• ISSN: 1545-1550
• DOI: 10.1177/1526602819854167

To evaluate the technical success, clinical success, and complication rates of endovascular revascularization for below-the-elbow (BTE) peripheral artery disease. 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. 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. Endovascular revascularization for BTE occlusive disease is an effective and safe strategy for treating CHI.