Tursunov B Z, Usmanov Kh Kh, Temirov S N
Central Hospital of the Ministry of Internal Affairs of the Republic of Uzbekistan, Tashkent, Uzbekistan.
Angiol Sosud Khir. 2018;24(4):64-68.
Presented herein are the results of treatment of five 63-to-72-year-old patients (four men and one woman) with critical upper limb ischaemia, which is one of rarely encountered pathologies. All patients suffered from type 2 diabetes mellitus. Two of them had end-stage renal disease (ESRD) and for 2 years were on haemodialysis. Four patients had gangrene of 1 finger and one patient had gangrene of 2 fingers. The main diagnostic methods included duplex scanning with measuring the gradient of pressure between the humeral and radial arteries, and MSCT angiography. The patients with ESRD received conservative therapy with the use of prostaglandin E1 and after limitation of necrosis sustained amputation of the fingers. Three patients were successfully managed by recanalization and balloon angioplasty of the radial artery's occluded segment. The patients underwent follow-up examinations at 1, 6, 12, 18 and 24 months. During this period two patients with ESRD died. They had no relapses of critical ischaemia of the hand but developed gangrene of toes and were both subjected to successful balloon angioplasty of the crural arteries. One patient at 18 postoperative months was found to have reocclusion of the radial artery with hand pain at rest. He was subjected to successful repeat balloon angioplasty of the radial artery. CONCLUSION: Timely restoration of blood flow in this situation reduces the frequency of amputation. Percutaneous balloon angioplasty may become a method of choice in treatment of patients with critical hand ischaemia caused by occlusive lesions of arteries of the forearm.
本文介绍了对5名63至72岁患有严重上肢缺血的患者（4名男性和1名女性）的治疗结果，严重上肢缺血是一种罕见的病症。所有患者均患有2型糖尿病。其中2人患有终末期肾病（ESRD），并已接受2年的血液透析治疗。4名患者有1根手指发生坏疽，1名患者有2根手指发生坏疽。主要诊断方法包括采用肱动脉和桡动脉之间压力梯度测量的双功超声扫描以及多层螺旋CT血管造影。患有ESRD的患者接受了使用前列腺素E1的保守治疗，在坏死范围得到控制后进行了手指截肢。3名患者通过对桡动脉闭塞段进行再通和球囊血管成形术成功得到治疗。患者在术后1、6、12、18和24个月接受了随访检查。在此期间，2名患有ESRD的患者死亡。他们手部严重缺血未复发，但出现了足趾坏疽，两人均成功接受了股动脉球囊血管成形术。1名患者在术后18个月被发现桡动脉再次闭塞，伴有静息时手部疼痛。他成功接受了桡动脉再次球囊血管成形术。结论：在这种情况下及时恢复血流可降低截肢频率。经皮球囊血管成形术可能成为治疗由前臂动脉闭塞性病变引起的严重手部缺血患者的首选方法。
