An Algorithmic Approach to the Surgical Treatment of Chronic Ischemia of the Hand: A Systematic Review of the Literature

Thibaudeau, Stéphanie; Serebrakian, Arman T.; Gerety, Patrick A.; Levin, L. Scott

doi:10.1097/prs.0000000000002044

Cited by 12 publications

(19 citation statements)

References 49 publications

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“…Endovascular therapy has not been part of contemporary clinical algorithms for surgical management of chronic hand ischemia. 6 As more endovascular experience is gained for BTE disease, the role of advanced revascularization techniques and tools is expected to expand, similar to the evolution of below-knee endovascular revascularization strategies. Bahro et al 8 evaluated 11 patients with 11 heavily calcified forearm arteries that were pretreated with orbital atherectomy prior to angioplasty, achieving 100% technical and 30-day clinical success for wound healing and freedom from repeat revascularization or amputation.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, endovascular revascularization is not part of current surgical management algorithms for CHI. 6 The purpose of this study was to assess the safety profile and technical and clinical success of endovascular revascularization for BTE lesions causing CHI.…”

Section: Introductionmentioning

confidence: 99%

“…Current surgical treatment algorithms for CHI recommend bypass in patients with a reconstructible segmental occlusion. 6 Because of the extent of the disease in many of these patients, surgical bypass is often infeasible.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, endovascular revascularization is not part of current surgical management algorithms for CHI. 6…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Notably, endovascular revascularization is not part of current surgical management algorithms for CHI. 6…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…These two methods can be complementary; however, in severely occluded cases, a periarterial sympathectomy alone is insu cient. In a recent systematic review, arterial reconstruction using an arterial bypass showed better results, including improved pain relief and wound healing, than did periarterial sympathectomy alone [15].…”

Section: Introductionmentioning

confidence: 99%

Long-term Results of Ulnar and Radial Reconstruction With Interpositional Grafting Using the Deep Inferior Epigastric Artery for Chronic Hand Ischemia

Ahn

Yoon

et al. 2021

Preprint

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Chronic hand ischemia causes cold intolerance, intractable pain, and digital ulceration. If ischemic symptoms persist despite pharmacologic treatments, surgical interventions should be considered. This retrospective study evaluated long-term results after ulnar and radial reconstruction using an interpositional deep inferior epigastric artery (DIEA) graft combined with periarterial sympathectomy. Patients who underwent this surgery from March 2003 to February 2019 were included. To evaluate variables influencing recurrence after the procedure, patients were divided into recurred and non-recurred groups and compared. Overall, 62 cases involving 47 patients were analyzed, with 16 and 46 cases in the recurred and non-recurred groups, respectively. The median length of DIEA grafts was 8.5 cm. Rates of rheumatic disease and female patients were significantly higher in the recurred group than in the non-recurred group, without significant between-group differences in postoperative complication rates. In the multivariate analysis, underlying rheumatic disease and graft length had significant effects on recurrence. In the Kaplan-Meier analysis, the 5- and 10-year symptom-free rates were 81.3% and 68.0%, respectively, with lower rates for cases with rheumatic disease. Thus, arterial reconstruction using an interpositional DIEA graft provides long-term sustainable vascular supply in chronic hand ischemia patients, especially those without rheumatic disease.

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Simultaneous bilateral distal venous arterialization between redial artery and cephalic vein in dorsal hand for Raynaud's phenomenon in both hands: A case report

et al. 2023

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Raynaud's phenomenon (RP) is characterized by episodic vasospasm in peripheral vessels and ischemia of the fingers. Venous arterialization is thought to induce neovascularization and increased oxygen tension. In this report, we describe a patient with RP in the fingers of both hands in whom venous arterialization achieved an acceptable result in both hands. The patient was a 62‐year‐old woman with a 10‐year history of worsening pain and cold sensation in the tips of the index, middle, ring, and little fingers on both sides. The venous arterialization procedure was performed on both hands simultaneously at the level of the anatomical snuff box between radial artery and cephalic vein in dorsal hand. There was no need for valvectomy in the level of hands. To prevent development of the steal phenomenon in the arterialized veins, the superficial basilic and median veins of the forearm were ligated via 1 cm skin incisions. The pain and cold sensation in the fingertips of both hands remained decreased, and the nonhealing ulcers on the fingertips healed without the need for amputation. The observation period was 14 months, and the surface temperature of the fingers was increased after venous arterialization, as was the temperature of the palm and forearm. There was no problem when administering intravenous infusion into the forearm on either side postoperatively. The case showed venous arterialization was effective for RP without increasing intravenous pressure in the affected limb, and further investigation is necessary.

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An Algorithmic Approach to the Surgical Treatment of Chronic Ischemia of the Hand: A Systematic Review of the Literature

Abstract: Therapeutic, IV.

Cited by 12 publications

References 49 publications

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

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

Long-term Results of Ulnar and Radial Reconstruction With Interpositional Grafting Using the Deep Inferior Epigastric Artery for Chronic Hand Ischemia

Simultaneous bilateral distal venous arterialization between redial artery and cephalic vein in dorsal hand for Raynaud's phenomenon in both hands: A case report

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