Hybrid method in treatment of rethrombosis of the arteries of the upper extremity
Abstract
The choice of
treatment for acute ischemia of the upper limb is an actual problem. In case of
thrombotic origin of acute occlusions, which occurs in 5% of cases, the success
of surgical treatment depends on timely diagnostics, of nature and
localization of arterial lesions.
The article
describes a case report of the successful treatment of the arterial
rethrombosis of the left upper limb with a hybrid method. The patient was
admitted with acute ischemia of the left upper limb. Previously a
thrombectomy was performed from the left axillar, left brachial artery
and left forearm arteries. Angiography showed: hemodynamically significant
80% stenosis of the left subclavian artery, occlusion between the middle
and the distal third of the brachial artery and the absence of flow in the
forearm arteries. Three-stage surgery was performed in the hybrid
operation room: stenting of the left subclavian artery, thrombectomy from
the left brachial artery and forearm arteries, balloon angioplasty of the
forearm arteries. CT-angiography performed after the surgery, confirmed
the restore of the blood flow at all levels. The patient was discharged at the
7th day after the operation with the compensated
circulation in the left upper limb.
Thus, the
possibility of providing emergency surgical care in a hybrid operating room for
acute upper limb ischemia caused by thrombosis has been demonstrated.
Keywords:hybrid surgery, retrombosis of the upper limb arteries, acute ischemia of the upper limb, reoperation, atherosclerosis of the upper limb arteries, hybrid operating room
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Mikhaylov I.P., Isaev G.A., Demjanov A.M., Kozlovskij
B.V., Arustamjan V.A., Matveev P.D., Parhomenko M.V., Taibova E.Z. Hybrid
method in treatment of rethrombosis of the arteries of the upper extremity.
Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (4): 65-9.
DOI: https://doi.org/10.33029/2308-1198-2021-9-4-65-69 (in Russian)
References
1. Bjorck M., Earnshaw J.J., Acosta S., et al. European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. 2020; 59 (2): 173-218. DOI: https://doi.org/10.1016/j.ejvs.2019.09.006
2. Mel’nikov M.V., Sotnikov A.V., Susla P.A., Pa-pava G.D. Acute upper limb ischemia: 30 years’ experience. Vestnik khirurgii imeni I.I. Grekova [Bulletin of Surgery named after I.I. Grekov]. 2019; 178 (4): 42-6. DOI: https://doi.org/10.24884/0042-4625-2019-178-4-42-46 (in Russian)
3. Andersen L.V., Lip G.Y.H., Lindholt J.S., Frost L. Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a metaanalysis of risk-modifying drugs. J Thromb Haemost. 2013; 11 (5): 836-44. DOI: https://doi.org/10.1111/jth.12181
4. Wong V.W., Major M.R., Higgins J.P. Nonoperative management of acute upper limb ischemia. Hand (NY). 2016; 11 (2): 131-43. DOI: https://doi.org/10.1177/1558944716628499
5. Ueda T., Murata S., Miki I., et al. Endovascular treatment strategy using catheter-directed thrombolysis, percutaneous aspiration thromboembolectomy, and angioplasty for acute upper limb ischemia. Cardiovasc Interv Radiol. 2017; 40 (7): 978-86. DOI: https://doi.org/10.1007/s00270-017-1599-z
6. Drozhzhin E.V., Zor’kin A.A., Kozlov A.V. Hybrid thrombectomy with embolism and occlusion of the main arteries of the lower extremities and using the complex Angiojet. Vestnik SurGU. Meditsina [Bulletin of Surgut State University. Medicine]. 2016; (2): 28-32. (in Russian)