Below-the-Elbow Revascularization for the Treatment of Upper Extremity Critical Limb Ischemia

Purpose: To report the results of below-the-elbow (BTE) arterial revascularization in patients with critical hand ischemia (CHI) and end-stage renal disease (ESRD)

Materials and Methods: We retrospectively identified all patients with critical limb ischemia treated with BTE arterial angioplasty, atherectomy, or both between 2013 and 2017. Patient demographics, comorbidities, and procedural data were reviewed. Rates of hand salvage and technical and clinical success were evaluated. The mean age at treatment was 59.7 years (50–72 years). The average time to follow-up was 9 months (2–26 months).

Results: Seven ESRD patients (3 women) with a total of 9 hands affected by BTE arterial occlusion and CHI were treated. The technical success rate was 88.9% (8 of 9). No major or minor complications occurred. Six hands (66.6%) had nonhealing ulcers and gangrene; the remaining 3 (33.3%) presented with rest pain. One patient died in the first 30 days of follow-up because of preexisting respiratory disease. The mean treated lesion length was 147.5 ± 97.9 mm. Among the successfully treated patients, the hand salvage rate was 87.5% (7 of 8). One patient did, however, undergo planned digital amputation after intervention with satisfactory healing of the postoperative stump.

Conclusions: Arterial revascularization of the BTE arteries for CHI is a safe and a technically feasible method to improve the hand salvage rate in patients with ESRD.