Endovascular Treatment of Critical Hand Ischemia: A Single-Center Experience

Morosetti, Daniele; D'Onofrio, Adolfo; Argirò, Renato; Martino, Arezia Di; Vidali, Sofia; Nezzo, Marco; Wlderk, Andrea; Ros, Valerio Da; Gandini, Roberto

doi:10.1016/j.carrev.2020.04.017

Cited by 3 publications

(13 citation statements)

References 18 publications

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“…As one of the early damaged organelles in ischemic/hypoxic injury, the mitochondrion plays a central role in cell material and energy metabolism. When the mitochondrial respiratory chain is damaged, the accumulation of ROS in mitochondria leads to oxidative stress and, eventually, mitochondrial dysfunction, which is a major contributor to organ injury (e.g., liver, kidney) [ 8 ]. Dynamin-related protein 1 (Drp1) is an important regulator of mitochondrial fission and affects the quantity of mitochondria.…”

Section: Introductionmentioning

confidence: 99%

Mdivi-1 attenuates oxidative stress and exerts vascular protection in ischemic/hypoxic injury by a mechanism independent of Drp1 GTPase activity

et al. 2020

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Vascular dysfunctions such as vascular hyporeactivity following ischemic/hypoxic injury are a major cause of death in injured patients. In this study, we showed that treatment with mitochondrial division inhibitor 1 (Mdivi-1), a selective inhibitor of dynamin-related protein 1 (Drp1), significantly improved vascular reactivity in ischemic rats by attenuating oxidative stress. The antioxidative effects of Mdivi-1 were relatively Drp1-independent, and possibly due to an increase in the levels of the antioxidant enzymes, SOD1 and catalase, as well as to enhanced Nrf2 expression. In addition, we found that while Mdivi-1 had little effect on Drp1 GTPase activity in vascular smooth muscle cells, it inhibited hypoxia-induced Drp1 phosphorylation at Ser-616, reducing excessive mitochondrial fission and slightly enhancing mitochondrial fusion. These effects possibly contributed to vascular protection at an early stage of ischemic/hypoxic injury. Finally, Mdivi-1 stabilized hemodynamics, increased vital organ perfusion, and improved rat survival after ischemic/hypoxic injury, proving a promising therapeutic agent for ischemic/hypoxic injury.

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Section: Introductionmentioning

confidence: 99%

Mdivi-1 attenuates oxidative stress and exerts vascular protection in ischemic/hypoxic injury by a mechanism independent of Drp1 GTPase activity

et al. 2020

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“…The restenosis rate varied from 18% to 44% at 6-48 months follow-up in 4 studies. 4,9,10,13 Primary patency, assisted primary patency, and secondary patency rates were reasonable at 38%, 46%, and 54% at 5 years, respectively. 13 Cheun et al showed that an intact palmar arch prior to intervention was predictive of cumulative patency.…”

Section: Discussionmentioning

confidence: 87%

“…Following full-text review, 8 articles remained that met the previously specified eligibility criteria. 3 , 4 , 6 - 10 , 13 …”

Section: Resultsmentioning

confidence: 99%

“… 4 , 5 There is usually a diffuse involvement of the BTE vessels, including the ulnar artery, radial artery, palmar arch, and digital vessels, with seldom isolated involvement of the interosseous artery. 4 - 10 Distal calcific arteriosclerosis plays a pivotal role in the pathophysiology of hand ischemia, particularly in hemodialysis patients. 5…”

Section: Introductionmentioning

confidence: 99%

“… 12 , 13 In the last 2 decades, several studies have shown promising results with percutaneous transluminal angioplasty (PTA) of BTE arteries for the management of CHI. 3 , 4 , 6 - 10 , 13 This systematic review aims to assess the feasibility, technical success, long-term outcomes, and complications of PTA for the treatment of CHI due to BTE arterial disease.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

et al. 2021

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Purpose: To perform a systematic review assessing the safety and efficacy of percutaneous transluminal angioplasty (PTA) for treatment of critical hand ischemia (CHI) due to below-the-elbow (BTE) obstructive arterial disease. Materials and Methods: MEDLINE and EMBASE systematic searches were performed from inception to December 2020 to identify studies assessing PTA for management of BTE obstructive arterial disease. Three independent reviewers performed abstract selection, data extraction, and quality assessment. The Newcastle-Ottawa Scale was used to assess individual study bias for non-randomized controlled trials. Results: Eight studies comprising 176 patients with obstructive BTE vessel disease were included. All studies had a score >5 on the Newcastle-Ottawa Scale, indicative of high quality. All studies used low-profile balloons (1.5–4 mm) for PTA of stenotic lesions or chronic total occlusions (CTOs). The weighted average technical success and clinical success rates were 89.3% (range = 82%–100%) and 69.9% (range = 19%–100%), respectively, at a mean follow-up of 29.7 ± 17.1 months. The short-term (<30 days) complication rate was low at 4.7% and most commonly included access site hematomas, pseudoaneurysms, and radial artery perforation or re-thrombosis. Nearly 20% of patients required an amputation, and most (96%) were minor (either distal phalanges or digits). Only 2 patients required above-wrist amputations. The primary and secondary patency rate at 5 years were 38% and 54%, respectively. The cumulative 5-year mortality rate was 33.1%. Conclusions: PTA for CHI due to BTE obstructive arterial disease is feasible with a high technical success rate and a low short-term complication rate. Additional long-term comparative studies are required to unequivocally establish the clinical benefit of endovascular treatment compared with conservative management or surgical bypass.

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Successful Endovascular Therapy for Total Occlusion of the Distal Radial and Ulnar Artery with Palmar Artery Lesion in a Patient with Critical Hand Ischemia Associated with Systemic Sclerosis

Kudoh

Zen

Yanishi

et al. 2022

Vasc Endovascular Surg

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Vasculopathy of systemic sclerosis (SSc) is known to lead to severe limb ischemia and is often associated with macrovascular diseases. Revascularization of proximal macrovascular lesions that cause limb ischemia in patients with SSc has been recommended; however, it has rarely been reported for lesions below-the-elbow (BTE) involving the palmar artery. A 66-year-old female patient with SSc experienced critical hand ischemia (CHI) with gangrene of the left third finger that failed to respond to conventional pharmacological treatment. Angiography revealed total occlusion of the distal radial and ulnar arteries with a palmar artery lesion. Balloon angioplasty was performed for bilateral occlusive lesions around the wrist, which improved antegrade flow to the digital artery. Endovascular therapy may be a feasible option for BTE lesions involving palmar artery disease, presenting with CHI in SSc, when conventional conservative treatments fail.

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Endovascular Treatment of Critical Hand Ischemia: A Single-Center Experience

Cited by 3 publications

References 18 publications

Mdivi-1 attenuates oxidative stress and exerts vascular protection in ischemic/hypoxic injury by a mechanism independent of Drp1 GTPase activity

Mdivi-1 attenuates oxidative stress and exerts vascular protection in ischemic/hypoxic injury by a mechanism independent of Drp1 GTPase activity

Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

Successful Endovascular Therapy for Total Occlusion of the Distal Radial and Ulnar Artery with Palmar Artery Lesion in a Patient with Critical Hand Ischemia Associated with Systemic Sclerosis

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