title: Angioplasty of ulnar or radial arteries to treat critical hand ischemia: use of 3- and 4-French systems.
abstract: OBJECTIVE
  The aim of this preliminary study is to report the results of catheter-based treatment for isolated distal upper extremity artery disease with CHI.
  
  
  BACKGROUND
  Critical hand ischemia (CHI) is a rare but potentially devastating condition.
  
  
  METHODS
  The study consisted of five critically ischemic hands (Rutherford category 4: 2, Rutherford category 5: 3) in four patients undergoing catheter intervention for isolated distal upper extremity artery disease between November 2007 and April 2009.
  
  
  RESULTS
  Balloon angioplasty via an antegrade brachial approach was performed with a 3Fr or 4Fr sheath to achieve the principal endpoint of the establishment of one straight-line flow to the palmar arch. All patients had end-stage renal disease requiring chronic hemodialysis. The target vessels were the ulnar artery in four cases, the radial artery in one, and the palmar arch in two. Four cases had a stenotic lesion and one had chronic total occlusion. Technical success was achieved in all cases without complications, and skin perfusion pressure of the hand improved significantly from 39 ± 20 to 52 ± 16 (P = 0.019) on the palmar side and from 40 ± 18 to 60 ± 29 on the dorsal side (P = 0.046). Clinical success was achieved in all cases during a mean follow-up period of 11 ± 8 (2-19) months.
  
  
  CONCLUSIONS
  Percutaneous angioplasty using contemporary dedicated devices could be a potentially useful option for CHI patients with isolated distal upper extremity artery disease.
authors.affiliation: Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada-City, Osaka, Japan. kawarada90@hotmail.com
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashimori
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D057785:Catheters; D003251:Constriction, Pathologic; D016638:Critical Illness; D004867:Equipment Design; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology