Browse > Article
http://dx.doi.org/10.3348/kjr.2011.12.5.595

Acute Upper Limb Ischemia due to Cardiac Origin Thromboembolism: the Usefulness of Percutaneous Aspiration Thromboembolectomy via a Transbrachial Approach  

Kim, Sung-Kwan (Department of Radiology, Chonbuk National University Hospital & Medical School)
Kwak, Hyo-Sung (Department of Radiology, Chonbuk National University Hospital & Medical School)
Chung, Gyoung-Ho (Department of Radiology, Chonbuk National University Hospital & Medical School)
Han, Young-Min (Department of Radiology, Chonbuk National University Hospital & Medical School)
Publication Information
Korean Journal of Radiology / v.12, no.5, 2011 , pp. 595-601 More about this Journal
Abstract
Objective: To evaluate the usefulness of percutaneous aspiration thromboembolectomy (PAT) via a transbrachial approach in patients with acute upper limb ischemia. Materials and Methods: From July 2004 to March 2008, eleven patients with acute upper limb ischemia were enrolled in this study. They were initially treated with thrombolysis (n = 1), PAT (n = 6), or both (n = 4) via a femoral artery approach. However, all of the patients had residual thrombus in the brachial artery, which was subsequently managed by PAT via the transbrachial approach for removal of residual emboli. Results: Successful re-canalization after PAT via a transbrachial approach was achieved in all patients. Two patients experienced early complications: one experienced a massive hematoma of the upper arm due to incomplete compression and was treated by stent deployment. The other patient experienced a re-occlusion of the brachial artery the day after the procedure due to excessive manual compression of the puncture site, but did not show recurrence of ischemic symptoms in the artery of the upper arm. Clinical success with complete resolution of ischemic symptoms was achieved in all patients. Conclusion: PAT via a transbrachial approach is a safe and effective treatment for patients with acute upper limb ischemia.
Keywords
Acute limb ischemia; Artery; Endovascular treatment;
Citations & Related Records

Times Cited By Web Of Science : 0  (Related Records In Web of Science)
Times Cited By SCOPUS : 2
연도 인용수 순위
  • Reference
1 Licht PB, Balezantis T, Wolff B, Baudier JF, Roder OC. Longterm outcome following thrombembolectomy in the upper extremity. Eur J Vasc Endovasc Surg 2004;28:508-512   DOI   ScienceOn
2 Lienemann A, Werle K, Weigert F. [Transbrachial arterial catheter angiography. Technique, indications, complications]. Radiologe 1993;33:102-107
3 Watkinson AF, Hartnell GG. Complications of direct brachial artery puncture for arteriography: a comparison of techniques. Clin Radiol 1991;44:189-191   DOI   ScienceOn
4 Lederer W, Dingler WH, Gaa J, Brand H, Zoller W, Deininger HK. [The value of the transbrachial approach for arterial visualization using a 4-F catheter]. Rofo 1989;151:674-677   DOI   ScienceOn
5 Chatziioannou A, Ladopoulos C, Mourikis D, Katsenis K, Spanomihos G, Vlachos L. Complications of lower-extremity outpatient arteriography via low brachial artery. Cardiovasc Intervent Radiol 2004;27:31-34
6 Ernst S, Fischbach R, Brochhagen HG, Heindel W, Landwehr P. Transbrachial thrombolysis, PTA and stenting in the lower extremities. Cardiovasc Intervent Radiol 2003;26:516-521
7 Lupattelli T, Clerissi J, Clerici G, Minnella DP, Casini A, Losa S, et al. The efficacy and safety of closure of brachial access using the AngioSeal closure device: experience with 161 interventions in diabetic patients with critical limb ischemia. J Vasc Surg 2008;47:782-788   DOI   ScienceOn
8 Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol 1997;29:1269-1275   DOI   ScienceOn
9 Al-Mubarak N, Vitek JJ, Iyer SS, New G, Roubin GS. Carotid stenting with distal-balloon protection via the transbrachial approach. J Endovasc Ther 2001;8:571-575   DOI   ScienceOn
10 Belenky A, Aranovich D, Greif F, Bachar G, Bartal G, Atar E. Use of a collagen-based device for closure of low brachial artery punctures. Cardiovasc Intervent Radiol 2007;30:273-275   DOI   ScienceOn
11 Galbraith K, Collin J, Morris PJ, Wood RF. Recent experience with arterial embolism of the limbs in a vascular unit. Ann R Coll Surg Engl 1985;67:30-33
12 Thompson JE, Sigler L, Raut PS, Austin DJ, Patman RD. Arterial embolectomy: a 20 year experience with 163 cases. Surgery 1970;67:212-220
13 Fogarty TJ, Cranley JJ, Krause RJ, Strasser ES, Hafner CD. A method for extraction of arterial emboli and thrombi. Surg Gynecol Obstet 1963;116:241-244
14 Thompson JE. Acute peripheral arterial occlusions. N Engl J Med 1974;290:950-952   DOI   ScienceOn
15 Schmidt FE, Hewitt RL. Severe upper limb ischemia. Arch Surg 1980;115:1188-1191   DOI   ScienceOn
16 Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 1998;338:1105-1111   DOI   ScienceOn
17 Tepe G, Hopfenzitz C, Dietz K, Wiskirchen J, Heller S, Ouriel K, et al. Peripheral arteries: treatment with antibodies of platelet receptors and reteplase for thrombolysis--APART trial. Radiology 2006;239:892-900   DOI   ScienceOn
18 Valji K, Bookstein JJ, Roberts AC, Sanchez RB. Occluded peripheral arteries and bypass grafts: lytic stagnation as an end point for pulse-spray pharmacomechanical thrombolysis. Radiology 1993;188:389-394
19 Muller-Hulsbeck S, Jahnke T. Peripheral arterial applications of percutaneous mechanical thrombectomy. Tech Vasc Interv Radiol 2003;6:22-34   DOI   ScienceOn
20 Ansel GM, Botti CF Jr, Silver MJ. Treatment of acute limb ischemia with a percutaneous mechanical thrombectomybased endovascular approach: 5-year limb salvage and survival results from a single center series. Catheter Cardiovasc Interv 2008;72:325-330   DOI   ScienceOn
21 Ouriel K. Endovascular techniques in the treatment of acute limb ischemia: thrombolytic agents, trials, and percutaneous mechanical thrombectomy techniques. Semin Vasc Surg 2003;16:270-279   DOI   ScienceOn
22 Ricotta JJ, Scudder PA, McAndrew JA, De Weese JA, May AG. Management of acute ischemia of the upper extremity. Am J Surg 1983;145:661-666   DOI   ScienceOn
23 Baguneid M, Dodd D, Fulford P, Hadjilucas Y, Bukhari M, Griffiths G, et al. Management of acute nontraumatic upper limb ischemia. Angiology 1999;50:715-720   DOI   ScienceOn
24 Bergqvist D, Ericsson BF, Konrad P, Bergentz SE. Arterial surgery of the upper extremity. World J Surg 1983;7:786-791   DOI   ScienceOn
25 Hernandez-Richter T, Angele MK, Helmberger T, Jauch KW, Lauterjung L, Schildberg FW. Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter. Langenbecks Arch Surg 2001;386:261-266   DOI   ScienceOn