La radiologia medica

, 116:919 | Cite as

Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature

Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
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Abstract

Purpose

This paper evaluates the indications, techniques, results, and complications of intra-arterial thrombolysis with or without a multihole microcatheter in three cases of acute hand ischaemia in comparison with the literature.

Materials and methods

Three men (mean age 39 years) with symptoms and signs of acute hand ischaemia (i.e. pain, pallor, cyanosis, decreased motor or sensory function) were studied with Doppler ultrasound and selective arteriography, which demonstrated acute clotting of wrist and/or hand arteries. They therefore underwent intra-arterial thrombolysis with the administration of urokinase and vasodilators and heparin if necessary, with (n=2) or without (n=1) multihole microcatheters.

Results

In all three cases, partial or complete recanalisation of the occluded arteries was achieved, with almost complete remission of clinical symptoms and good recovery of hand function.

Conclusions

Percutaneous intra-arterial thrombolysis is an effective therapeutic approach in cases of acute hand ischaemia and is a valid alternative to surgical thrombectomy. Multihole microcatheters allow the thrombolytic agent to be distributed more evenly into the clot and may help to reduce reactive arterial spasm.

Keywords

Intra-arterial thrombolysis Acute hand ischaemia Urokinase Microcatheter 

Trombolisi endoarteriosa nell’ischemia acuta della mano senza o con microcatetere: esperienza preliminare e confronto con la letteratura

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare indicazioni, tecnica, risultati e complicanze della procedura di trombolisi endoarteriosa senza o con microcatetere multiforato in 3 casi di lesioni ischemiche acute della mano e confrontarli con i dati della letteratura.

Materiali e metodi

Tre pazienti maschi (età media 39 anni) con sintomi e segni di lesione ischemica acuta della mano (dolore, pallore, cianosi ungueale, deficit sensoriale e motorio) sono stati sottoposti dapprima ad esame eco-color doppler e, quindi, ad angiografia selettiva, portando alla identificazione di un’occlusione trombotica acuta di arterie del polso e/o della mano; pertanto sono stati sottoposti a trattamento trombolitico endoarterioso mediante somministrazione di urochinasi e di vasodilatatori, e, al bisogno, di eparina, con (2 casi) o senza (1 caso) microcatetere multiforato.

Risultati

In tutti e 3 i casi si è osservata una ricanalizzazione parziale o completa delle arterie precedentemente occluse con remissione pressoché completa della sintomatologia clinica e buon recupero funzionale.

Conclusioni

La terapia trombolitica endoarteriosa percutanea rappresenta una valida opzione terapeutica nei casi di ischemia acuta della mano e costituisce una valida alternativa alla trombectomia chirurgica. Il microcatetere multiforato è un utile supporto che permette una più omogenea distribuzione dell’agente trombolitico all’interno del coagulo e può ridurre lo spasmo arterioso reattivo.

Parole chiave

Trombolisi intra-arteriosa Ischemia acuta della mano Urochinasi Microcatetere 
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References/Bibliografia

  1. 1.
    Lambiase RE, Paolella LP, Haas RA et al (1991) Extensive thromboembolic disease of the hand and forearm: treatment with thrombolytic therapy. J Vasc Intervent Radiol 2:201–208CrossRefGoogle Scholar
  2. 2.
    Johnson SP, Durham JD, Subber SW et al (1999) Acute arterial occlusions of the small vessels of the hand and the forearm: treatment with regional urokinase therapy. J Vasc Intervent Radiol 10:869–876CrossRefGoogle Scholar
  3. 3.
    Wheatley MJ, Marx MV (1996) The use of intra-arterial urokinase in the management of hand ischemia secondary to palmar and digital arterial occlusion. Ann Plast Surg 37:356–363PubMedCrossRefGoogle Scholar
  4. 4.
    Valji K, Hye RJ, Roberts AC et al (1995) Hand ischemia in patients with hemodialysis access graft: angiographic diagnosis and treatment. Radiology 196:697–701PubMedGoogle Scholar
  5. 5.
    Katz SG, Kohl RD (1993) Direct revascularization for the treatment of forearm and hand ischemia. Am J Surg 165:312–316PubMedCrossRefGoogle Scholar
  6. 6.
    Hess H, Mietaschk A, Bruckl R (1987) Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy. Radiology 163:753–758PubMedGoogle Scholar
  7. 7.
    Moss DP, Forthman CL (2008) Ulnar artery thrombosis associated with anomalous hypothenar muscle. J Surg Orthop Adv 17:85–88PubMedGoogle Scholar
  8. 8.
    Kreitner KF, Duber C, Muller LP et al (1996) Hypothenar hammer syndrome caused by recreational sports activities and muscle anomaly in the wrist. Cardiovasc Intervent Radiol 19:356–359PubMedCrossRefGoogle Scholar
  9. 9.
    Mc Cready RA, Bryant MA, Divelbiss JL (2008) Combined thenar and hypothenar hammer syndromes: case report and review of the literature. J Vasc Surg 48:741–744CrossRefGoogle Scholar
  10. 10.
    Dineen S, Smith S, Arko FR (2007) Successful percutaneous angioplasty and stenting of the radial artery in a patient with chronic upper extremity ischemia and digital gangrene. J Endovasc Ther 14:426–428PubMedCrossRefGoogle Scholar
  11. 11.
    Valji K, Bookstein JJ, Roberts AC et al (1991) Pharmacomechanical thrombolysis and angioplasty in the management of clotted hemodialysis graft: early and late clinical results. Radiology 178:243–247PubMedGoogle Scholar
  12. 12.
    Widlus DM, Venbrux AC, Benenati JF et al (1990) Fibrinolytic therapy for upper extremity arterial occlusions. Radiology 175:393–399PubMedGoogle Scholar
  13. 13.
    Coughlin PA, Mavor AI (2006) Arterial consequences of recreational drug use. Eur J Vasc Endovasc Surg 32:389–396PubMedCrossRefGoogle Scholar
  14. 14.
    Becquemin JP, Etienne J, Schaeffer A et al (1986) Acute ischemia of the extremities and drug addiction. J Mal Vasc 11:35–38PubMedGoogle Scholar
  15. 15.
    Klabacha ME, Miller SH, Pav JM et al (1984) Inadvertent intraradial arterial injection of cocaine. Ann Plast Surg 13:60–62PubMedCrossRefGoogle Scholar
  16. 16.
    Stover MC, Perrone J (2006) Vascular occlusion after intraarterial cocaine injection. N Engl J Med 355:2021PubMedCrossRefGoogle Scholar
  17. 17.
    Simon RW, Pfammatter T, Amann-Vesti BR (2008) Accidental intraarterial cocaine injection. J Vasc Intervent Radiol 19:1124–1125CrossRefGoogle Scholar
  18. 18.
    Connell DA, Koulouris G, Thorn DA et al (2002) Contrast-enhanced MR angiography of the hand. Radiographics 22:583–599PubMedGoogle Scholar
  19. 19.
    Nehler MR, Dalmar RL, Harris EJ et al (1992) Upper extremity arterial bypass distal to the wrist. J Vasc Surg 16:633–640PubMedCrossRefGoogle Scholar
  20. 20.
    Rose SC, Kadir S (1991) Arterial anatomy of the upper extremities. In: Kadir S (ed) Atlas of normal and variant angiographic anatomy. Saunders, Philadelphia, pp 55–62Google Scholar
  21. 21.
    McCarthy WJ, Flinn WR, Yao JS et al (1986) Result of bypass grafting for upper limb ischemia. J Vasc Surg 3:741–746PubMedGoogle Scholar
  22. 22.
    Chang BB, Roddy SP, Darling III RC et al (2003) Upper extremity bypass grafting for limb salvage in end-stage renal failure. J Vasc Surg 38:1313–1315PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • G. Barbiero
    • 1
    • 3
  • D. Cognolato
    • 2
  • A. Casarin
    • 1
  • A. Guarise
    • 1
  1. 1.Struttura Complessa di RadiologiaOspedale San BassianoBassano del GrappaItaly
  2. 2.Struttura Complessa di Chirurgia VascolareOspedale San BassianoBassano del GrappaItaly
  3. 3.PadovaItaly

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