Department of Cardiovascular Medicine, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan.
Vasc Endovascular Surg. 2022 Apr;56(3):340-343. doi: 10.1177/15385744211037491. Epub 2022 Feb 11.
Vasculopathy of systemic sclerosis (SSc) is known to lead to severe limb ischemia and is often associated with macrovascular diseases. Revascularization of proximal macrovascular lesions that cause limb ischemia in patients with SSc has been recommended; however, it has rarely been reported for lesions below-the-elbow (BTE) involving the palmar artery. A 66-year-old female patient with SSc experienced critical hand ischemia (CHI) with gangrene of the left third finger that failed to respond to conventional pharmacological treatment. Angiography revealed total occlusion of the distal radial and ulnar arteries with a palmar artery lesion. Balloon angioplasty was performed for bilateral occlusive lesions around the wrist, which improved antegrade flow to the digital artery. Endovascular therapy may be a feasible option for BTE lesions involving palmar artery disease, presenting with CHI in SSc, when conventional conservative treatments fail.
系统性硬化症（SSc）的血管病变可导致严重的肢体缺血，常伴有大血管疾病。建议对导致 SSc 患者肢体缺血的近端大血管病变进行血运重建；然而，对于涉及掌动脉的 BTE 病变，很少有报道。一名 66 岁的女性 SSc 患者发生了左手第三指干性坏死的严重手部缺血（CHI），常规药物治疗无效。血管造影显示远端桡动脉和尺动脉完全闭塞，掌动脉病变。腕部双侧闭塞性病变行球囊血管成形术，改善了向指动脉的顺行血流。当常规保守治疗失败时，对于合并 CHI 的 SSc 患者出现的累及掌动脉疾病的 BTE 病变，血管内治疗可能是一种可行的选择。
