Giusca Sorin, Schmidt Andrej, Korosoglou Grigorios
Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Roentgenstrasse 1, Weinheim D-69469, Germany.
Department of Interventional Angiology, University Hospital Leipzig, Leipzig, Germany.
Eur Heart J Case Rep. 2022 May 24;6(7):ytac215. doi: 10.1093/ehjcr/ytac215. eCollection 2022 Jul.
Patients with acute limb ischaemia (ALI) present with acute symptoms, requiring prompt diagnosis and expedited treatment to preserve the viability of the affected ischaemic tissue.
We present an 83-year-old female patient with upper ALI due to thrombotic occlusion of the left brachial artery. Concomitantly, the patient had a first diagnosis of atrial fibrillation and was not on treatment with oral anticoagulation. Transfemoral thrombectomy using a 6F Rotarex® catheter resulted in removal of the thrombus from the brachial artery. However, significant amounts of debris embolized distally, causing occlusion of both the radial and ulnar arteries. The debris was successfully removed after puncture of the distal radial artery and retrograde thrombus aspiration using a 5F Envoy catheter. This manoeuver led to flow restoration in both the radial and ulnar arteries and to complete resolution of ischaemic symptoms of the patient.
Interventionists may consider distal radial puncture not only as an access site for coronary angiography but also as an option for the endovascular management of ALI in cases of cardiac embolism, as described herein or in cases of thrombotic complications during routine catheterization and percutaneous coronary intervention. Herein, we describe the case of an 83-year-old patient, who presented with acute upper limb ischaemia. Due to embolization of thrombotic debris during Rotarex® catheter thrombectomy, flow further diminished in the ulnar and radial arteries. The last hope for successful interventional treatment was thrombectomy from distally after retrograde puncture of the distal radial artery. This unique manoeuver led to flow restoration and complete recovery of the patient without the need for open surgery.
急性肢体缺血（ALI）患者表现出急性症状，需要迅速诊断并加快治疗，以维持受影响缺血组织的存活能力。
我们报告一名83岁女性患者，因左肱动脉血栓形成闭塞导致上肢ALI。同时，该患者首次诊断为房颤，未接受口服抗凝治疗。使用6F Rotarex®导管经股动脉进行血栓切除术成功清除了肱动脉内的血栓。然而，大量碎片向远端栓塞，导致桡动脉和尺动脉均闭塞。通过穿刺桡动脉远端并使用5F Envoy导管进行逆行血栓抽吸，成功清除了碎片。这一操作使桡动脉和尺动脉血流恢复，患者缺血症状完全缓解。
介入医生不仅可将桡动脉远端穿刺视为冠状动脉造影的入路部位，在本文所述的心脏栓塞病例或常规导管插入术及经皮冠状动脉介入治疗期间发生血栓并发症的情况下，也可将其作为ALI血管内治疗的一种选择。在此，我们描述了一名83岁患者出现急性上肢缺血的病例。在使用Rotarex®导管进行血栓切除术期间，由于血栓碎片栓塞，尺动脉和桡动脉血流进一步减少。成功进行介入治疗的最后希望是在桡动脉远端逆行穿刺后从远端进行血栓切除术。这一独特操作使血流恢复，患者完全康复，无需进行开放手术。
