Percutaneous Transluminal Angioplasty for Below-the-Elbow Critical Hand Ischemia: A Systematic Review

Author:

Awad El-Karim Ghassan1ORCID,Kennedy Sean A.1,Ferraresi Roberto2ORCID,Addas Jamil A.K.1,Oreopoulos George D.13,Jaberi Arash1,Tan Kong Teng1ORCID,Mafeld Sebastian1

Affiliation:

1. Division of Interventional Radiology, University Health Network, Toronto, ON, Canada

2. Centro per la cura del Piede Diabetico, Clinica San Carlo, Paderno Dugnano, MI, Italy

3. Division of Vascular Surgery, University Health Network, Toronto, ON, Canada

Abstract

Purpose: To perform a systematic review assessing the safety and efficacy of percutaneous transluminal angioplasty (PTA) for treatment of critical hand ischemia (CHI) due to below-the-elbow (BTE) obstructive arterial disease. Materials and Methods: MEDLINE and EMBASE systematic searches were performed from inception to December 2020 to identify studies assessing PTA for management of BTE obstructive arterial disease. Three independent reviewers performed abstract selection, data extraction, and quality assessment. The Newcastle-Ottawa Scale was used to assess individual study bias for non-randomized controlled trials. Results: Eight studies comprising 176 patients with obstructive BTE vessel disease were included. All studies had a score >5 on the Newcastle-Ottawa Scale, indicative of high quality. All studies used low-profile balloons (1.5–4 mm) for PTA of stenotic lesions or chronic total occlusions (CTOs). The weighted average technical success and clinical success rates were 89.3% (range = 82%–100%) and 69.9% (range = 19%–100%), respectively, at a mean follow-up of 29.7 ± 17.1 months. The short-term (<30 days) complication rate was low at 4.7% and most commonly included access site hematomas, pseudoaneurysms, and radial artery perforation or re-thrombosis. Nearly 20% of patients required an amputation, and most (96%) were minor (either distal phalanges or digits). Only 2 patients required above-wrist amputations. The primary and secondary patency rate at 5 years were 38% and 54%, respectively. The cumulative 5-year mortality rate was 33.1%. Conclusions: PTA for CHI due to BTE obstructive arterial disease is feasible with a high technical success rate and a low short-term complication rate. Additional long-term comparative studies are required to unequivocally establish the clinical benefit of endovascular treatment compared with conservative management or surgical bypass.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,Surgery

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