Directional atherectomy of a heavy calcified axillary artery stenosis inducing critical hand ischemia.
The presence of a severe calcified peripheral artery lesion is responsible for a poor response to balloon dilation, due to significant acute vessel recoil and frequent flow-limiting dissections requiring stent implantation. This possibility could be associated with very high compression and/or fracture rates particularly in cases of lesion located at the mobile joints. In this setting directional atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the restenosis rate by direct plaque excision. In this report, we present a case of critical hand ischemia due to a heavily calcified axillary artery lesion managed by directional atherectomy and balloon angioplasty followed by immediate angiographic success and sustained clinical benefit up to 3 years of follow-up.
Catheterization Laboratory, Cardio-Vascular Department, Istituto Clinico Humanitas Mater Domini, Via Gerenzano 2, 21053, Castellanza, VA, Italy. anzangelo@yahoo.com
Angelo
A
Anzuini
Altin
A
Palloshi
Gianfranco
G
Aprigliano
Alfonso
A
Ielasi
D000369:Aged, 80 and over; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017073:Atherectomy / Q000379:methods*; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index