Optical Coherence Tomography in Peripheral Vasculature

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VASCULAR DISEASE MANAGEMENT 2024;21(5):E30-E32

Case Report

A 45-year-old woman, who was a nonsmoker with a known case of hypertension, presented with a history of pain in her right upper limb on exertion for the past 6 months. There was no history of any neurological symptoms, trauma, or giddiness/syncope. Clinical examination revealed absent brachial, radial, and ulnar pulses with palpable subclavian and axillary pulses. Upper right limb temperature was the same as the left upper limb. There was no evidence of a cervical rib. Neurological examination was unremarkable, and contralateral upper limb and bilateral lower limb pulses were palpable. There was a pressure difference of 30 mm Hg in the brachial artery between the 2 upper limbs. Color Doppler revealed occlusion in the proximal and mid-brachial arteries with reformation of the distal brachial, radial, and ulnar arteries. A right transbrachial angioplasty/stenting was planned under optical coherence tomography (OCT) guidance.

The right brachial artery was punctured under ultrasound guidance using a micropuncture set, and a 6F haemostatic sheath was placed. A check angiography image was taken to define the lesion in the distal axillary and proximal brachial artery (Figure 1A). A 0.014-inch wire platform was used to introduce the Dragonfly OPTIS OCT catheter (Abbott Cardiovascular), and pre-dilatation pullback images were obtained (Figures 1B-D) to define the extent and morphology of the lesion along with the luminal area of the vessel along the whole extent of the lesion. Images showed a thrombotic lesion with a mix of red and white thrombus (Figure 2). Angioplasty was done using a 5-mm x 60-mm balloon. Repeat pullback images were taken, along with angiography images, to define the post-angioplasty status (Figures 3A-D), which showed luminal gain along with good flow across the lesion. Post procedure, the right brachial, radial, and ulnar pulses were palpable. n

The authors report no financial relationships or conflicts of interest regarding the content herein. 

Manuscript accepted April 9, 2024. 

Address for Correspondence: Dr. Jha Manvendu, Department of Vascular Surgery, Army Hospital Research & Referral, New Delhi, India. Email: manviparijat@gmail.com