Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study).

INTRODUCTION: Supervised exercise training is among the first-line therapies for patients with peripheral artery disease (PAD). Current recommendations for exercise include guidance focusing on claudication pain, programme and session duration, and frequency. However, no guidance is offered regarding exercise training intensity. This study aims to compare the effects of 12-week-long supervised walking exercise training (high-intensity interval training (HIIT) vs moderate-intensity exercise (MOD)) in patients with chronic symptomatic PAD. METHODS AND ANALYSIS: This study is a monocentric, interventional, non-blinded randomised controlled trial. 60 patients (30 in each group) will be randomly allocated (by using the random permuted blocks) to 12 weeks (three times a week) of HIIT or MOD. For HIIT, exercise sessions will consist of alternating brief high-intensity (≥85% of the peak heart rate (HRpeak)) periods (≤60 s) of work with periods of passive rest. Patients will be asked to complete 1 and then 2 sets of 5-7 (progressing to 10-15×60 s) walking intervals. For the MOD group, exercise training sessions will consist of an alternation of periods of work performed at moderate intensity (≤76% HRpeak) and periods of passive rest. Interventions will be matched by training load. The primary outcome will be the maximal walking distance. Secondary outcomes will include functional performance, functional capacity, heath-related quality of life, self-perceived walking abilities, physical activity and haemodynamic parameters. ETHICS AND DISSEMINATION: The Angiof-HIIT Study was approved by the Human Research Ethics Committee of the Canton de Vaud (study number: 2022-01752). Written consent is mandatory prior to enrolment and randomisation. The results will be disseminated via national and international scientific meetings, scientific peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: NCT05612945.

Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case.

Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.

[Role of lymphofluoroscopy in the management of lymphedema]. / Place de la lymphofluoroscopie dans la prise en charge du lymphœdème.

The lymphatic vascular system is essential for maintaining a healthy balance between interstitial fluid production and transport. Dysregulation of this balance can lead to the formation of lymphedema, a pathology that is disabling and bothersome in the daily lives of the patients. Lymphofluoroscopy is an invaluable tool that provides static and dynamic images of the superficial lymphatic vessels, with diagnostic and therapeutic implications. This diagnostic tool is beginning to take its place in the field of lymphology, as it is minimally invasive and has virtually no side effects.

Le système lymphatique vasculaire est essentiel pour maintenir un bon équilibre entre la production et le transport du liquide interstitiel. Une dysrégulation de cette balance peut amener à la formation d'un lymphœdème, pathologie invalidante et gênante dans la vie quotidienne des patients. La lymphofluoroscopie est un instrument précieux qui permet, avec des images statiques et dynamiques, d'observer le système vasculaire lymphatique superficiel, avec des implications diagnostiques et thérapeutiques importantes. Cet instrument diagnostic commence à prendre sa place dans le domaine de la lymphologie, car il est peu invasif et quasiment sans effet secondaire.

[Peripheral arterial disease of the lower limbs : from diagnosis to treatment]. / Maladie artérielle périphérique : du diagnostic au traitement.

Peripheral arterial disease of the lower limbs (PAD) is a widespread disease whose diagnosis and treatment are still inadequate, despite several available current national and international recommendations. Screening for PAD is recommended in patients presenting with lower limb symptoms (claudication) and in those at risk. For all patients with PAD, initial management measures include treatment of cardiovascular risk factors, lifestyle modification, exercise training and antithrombotic therapy, at least for any symptomatic PAD. Revascularization is discussed on a case-by-case basis, depending on the stage of the disease, in a multidisciplinary setting. A diagnostic algorithm for PAD is presented, together with the basic principles of comprehensive disease management.

La maladie artérielle périphérique des membres inférieurs (MAP) est une maladie très répandue dont le diagnostic et le traitement sont encore insuffisants malgré l'existence de plusieurs recommandations nationales et internationales. Le dépistage de la MAP est recommandé chez les patients présentant des symptômes au niveau des membres inférieurs (claudication) et chez les personnes à risque. La prise en charge initiale de la MAP comprend le traitement des facteurs de risque cardiovasculaire, la modification du mode de vie, l'entraînement à l'exercice physique et le traitement antithrombotique, si symptomatique. La revascularisation est discutée au cas par cas en fonction du stade de la maladie dans un cadre multidisciplinaire. Un algorithme diagnostique de la MAP ainsi que les bases de prise en charge globale de la maladie sont présentés.

[Pelvic congestion syndrome : from diagnosis to treatment]. / Syndrome de congestion pelvienne : du diagnostic au traitement.

Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients.

Le syndrome de congestion pelvienne est une maladie invalidante souvent sous-diagnostiquée et sous-traitée, définie par de douleurs pelviennes chroniques, en présence de varices pelviennes chez les femmes ou plus rarement les hommes. Le diagnostic différentiel des douleurs chroniques abdominales est vaste et mène souvent à des parcours diagnostiques longs et coûteux. Le traitement conservateur est souvent insuffisant et une embolisation des varices pelviennes est le traitement de choix pour améliorer la symptomatologie. Un algorithme de prise en charge multidisciplinaire est proposé afin de faciliter le parcours de soins de ces patients.

The link between impaired oxygen supply and cognitive decline in peripheral artery disease.

Although peripheral artery disease (PAD) primarily affects large arteries outside the brain, PAD is also associated with elevated cerebral vulnerabilities, including greater risks for brain injury (such as stroke), cognitive decline and dementia. In the present review, we aim to evaluate recent literature and extract information on potential mechanisms linking PAD and consequences on the brain. Furthermore, we suggest novel therapeutic avenues to mitigate cognitive decline and reduce risk of brain injury in patients with PAD. Various interventions, notably exercise, directly or indirectly improve systemic blood flow and oxygen supply and are effective strategies in patients with PAD or cognitive decline. Moreover, triggering protective cellular and systemic mechanisms by modulating inspired oxygen concentrations are emerging as potential novel treatment strategies. While several genetic and pharmacological approaches to modulate adaptations to hypoxia showed promising results in preclinical models of PAD, no clear benefits have yet been clinically demonstrated. We argue that genetic/pharmacological regulation of the involved adaptive systems remains challenging but that therapeutic variation of inspired oxygen levels (e.g., hypoxia conditioning) are promising future interventions to mitigate associated cognitive decline in patients with PAD.

[Physical therapy in vascular diseases]. / L'exercice physique dans les maladies vasculaires.

Regular physical exercise reduces the risk of developing cardiovascular diseases. Along with cardiovascular risk factors management, physical exercise is considered as one of the main treatment components in people with cardiovascular diseases. The therapeutic role of physical exercise in patients with peripheral artery disease has been highlighted for decades. However, the role of physical exercise in the management of patients with venous, lymphatic, or rare vascular diseases remains poorly investigated. This article discuss the potential benefits of physical exercise in the therapeutic care of patients with vascular diseases.

Il est bien connu que l'exercice physique régulier diminue le risque de contracter une maladie cardiovasculaire. Chez les personnes avec une maladie cardiovasculaire, l'exercice physique est considéré, avec le contrôle strict des facteurs de risque cardiovasculaire, comme un élément capital de la prise en charge. Depuis des décennies, on met en évidence le rôle de l'exercice physique dans l'amélioration de la mobilité et de la qualité de vie des patient-e-s avec une maladie artérielle périphérique. Cependant, le rôle de l'exercice physique dans la prise en charge des patient-e-s avec des maladies veineuses, lymphatiques ou des maladies vasculaires rares demeure peu investigué. Cet article met en évidence les potentiels bénéfices de l'exercice physique dans la prise en charge des patient-e-s avec des maladies vasculaires.

Lymphatic malformations in children: retrospective review of surgical and interventional management.

PURPOSE: Lymphatic malformations (LMs) are classified as macrocystic, microcystic or mixed. Treatment depends on their characteristics: surgery, sclerotherapy, both combined, systemic treatment or observation. This study aims to analyze the surgical and interventional management of LMs in children over the last two decades in our university hospital. METHODS: Management of children born with LMs between 2000 and 2019 was reviewed. Parameters collected were: malformation characteristics, type of treatment, symptoms, imaging, timing of diagnosis and first treatment, number of interventions, recovery rate, complications and length of stay. RESULTS: Files of 48 children were reviewed: 27 with macrocystic and 21 with microcystic LMs. There was no statistically significant difference in type of treatment except for combined treatment, more performed in microcystic LMs (p = 0.04). Symptoms, imaging, timing of diagnosis and first treatment, number of interventions and complications were not statistically significant. Overall, the number of surgeries was lower than sclerotherapies (p = 0.04). Recovery rate after surgery was higher in macrocystic LMs (p = 0.01). Complications and length of stay were not statistically significant. CONCLUSION: A good rate of recovery was observed when surgery was performed, with no significant increase in complications and length of stay. A prospective study will be determinant to create a decisional algorithm for children with LMs.

Venous malformation of the penis treated with a combined Nd:YAG laser and sclerotherapy technique.

Venous malformations are the commonest vascular anomalies and can be found everywhere in the body. Those of the external genitalia are quite rare. Although they can be small, they may give rise to psychological discomfort and functional impairment and their management can be delicate and challenging. We present a case of a large and infiltrating venous malformation of the glans penis successfully treated with a combined strategy using sclerotherapy and Nd:YAG laser.

[Who do you screen for an abdominal aortic aneurysm ?] / Chez qui effectuer un dépistage de l'anévrisme de l'aorte abdominale ?

Abdominal aortic aneurysm (AAA) represents an important public health problem. The early detection and treatment as well as follow-up of an AAA are important to reduce the high mortality rate associated with its rupture. Despite the decline of the prevalence of AAA in the last decades, the latest international recommendations have reaffirmed that screening in men remains cost-effective. In contrast, the data and recommendations for women are unclear. The best method for AAA screening is abdominal ultrasound. The aim of this paper is to present an up-to-date review of the indications for AAA screening based on the latest recommendations.

L'anévrisme de l'aorte abdominale (AAA) reste toujours un problème de santé publique malgré les progrès technologiques réalisés dans sa prise en charge. Le diagnostic précoce et le traitement ainsi que le suivi d'un AAA sont importants pour prévenir le taux de mortalité très élevé associé à sa rupture. Bien que la prévalence de l'AAA ait diminué ces dernières décennies, les dernières recommandations internationales ont réaffirmé qu'un dépistage chez les hommes reste rentable. En revanche, les données et les recommandations concernant la femme ne sont pas claires. L'examen de choix pour le dépistage des AAA est l'échographie abdominale. Cet article vise à mettre à jour les indications de dépistage de l'AAA en fonction des dernières recommandations.

The effects of COVID-19 pandemic on patients with lower extremity peripheral arterial disease: A near miss disaster.

BACKGROUND: The COVID-19 pandemic has led to widespread postponement and cancelation of elective vascular surgeries in Switzerland. The consequences of these decisions are poorly understood. PATIENTS AND METHODS: In this observational, retrospective, single-center cohort study, we describe the impact of COVID-19 pandemic containment strategies on patients with lower extremity peripheral arterial disease (PAD) referred during the period March 11, to May 11, 2020, compared to the same time frames in 2018 to 2019. Patients admitted for acute limb ischemia (ALI) or chronic PAD and undergoing urgent or elective vascular surgery or primary amputation were included. Patients' characteristics, indications for admission, and surgical features were analyzed. The occurrence of 30 day outcomes was assessed, including length of stay, rates of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), and procedural and hemodynamic success. RESULTS: Overall, 166 patients were included. Fewer subjects per 10 day period were operated in 2020 compared to, 2018 to 2019 (6.7 vs. 10.5, respectively; P < 0.001). The former had higher rates of chronic obstructive pulmonary disease (COPD) (25% vs. 11.1%; P = 0.029), and ASA score (3.13 vs. 2.90; P = 0.015). The percentage of patients with ALI in 2020 was about double that of the same period in 2018 to 2019 (47.5% vs. 24.6%; P = 0.006). Overall, the types of surgery were similar between 2020 and 2018 to 2019, while palliative care and primary amputations occurred only in 2020 (5 out 40 cases). The rate of post-operative MACE was significantly higher in 2020 (10% vs. 2.4%; P = 0.037). CONCLUSIONS: During the first state of emergency for COVID-19 pandemic in 2020, less regular medical follow-up and hindered hospital access could have resulted in more acute and advanced clinical presentations of patients with PAD undergoing surgery. Guidelines are needed to provide appropriate care to this vulnerable population and avoid a large-scale disaster.

Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treatment of large intramuscular venous malformations.

BACKGROUND: Among vascular anomalies, congenital venous malformations (VMs) are the most common lesions. Treatment of VMs is sometimes difficult or cumbersome, depending on their size and tissue involvement. Surgery may lead to invasive and mutilating excisions, often allowing only partial removal, with an increased risk of recurrence. Sclerotherapy is a mainstream technique, resulting in endothelium destruction, fibrosis and subsequent shrinkage of the vascular lesion, also with a risk of recurrence. However, this technique may not be efficient in cases of large and infiltrating VMs. Endovenous thermal ablation has been found to be more effective than sclerotherapy for transmural vascular destruction and has therefore been employed in the treatment of VMs. METHODS: In this study we described a combined technique for the treatment of large intramuscular VMs in seven consecutive patients, associating endovenous laser ablation with sclerotherapy. The aim was to assess feasibility and safety of the procedure. RESULTS: We reported a high immediate technical success, clinical and radiological improvement, with no complications. CONCLUSIONS: The preliminary results presented herein show, that combining EVLA and sclerotherapy for the treatment of voluminous persistent intramuscular VM is safe and technically feasible. The combination of a wide direct intimal thermal damage with chemical sclerotherapy is the force of this approach. The small number of cases and the medium term follow up represent though a limitation.

[Advances in the treatment of complex venous malformation: endovenous laser]. / Nouveautés dans le traitement des malformations veineuses complexes : le laser endoveineux.

Congenital venous malformations (VMs) are the most common vascular abnormalities. Their treatment can be complex, depending on their size and surrounding tissues involvement. To date, sclerotherapy is considered the gold standard for the treatment of VMs. This technique, which aims to destroy the endothelium and thus cause fibrosis and retraction of the vascular lesion, is less effective in voluminous VMs. Endovenous thermal ablation is a widely validated treatment in the management of venous insufficiency, showing better efficacy than sclerotherapy in terms of trans-parietal vessel destruction. This approach has therefore also been described in the treatment of VMs. This technique has been introduced for the treatment of complex VMs at the Centre for Malformations and Rare Vascular Diseases of the CHUV.

Les malformations veineuses (MV) congénitales sont les anomalies vasculaires les plus fréquentes. Leur traitement peut être complexe en fonction de leur taille ou de l'atteinte des tissus avoisinants. À ce jour, la sclérothérapie est considérée comme le Gold Standard du traitement des MV. Cette technique, qui vise à détruire l'endothélium et à causer ainsi une fibrose et une rétraction de la lésion vasculaire, est moins efficace dans le cas des grandes MV. L'ablation thermique endoveineuse, largement validée dans le traitement de l'insuffisance veineuse, s'est révélée plus efficace que la sclérothérapie pour la destruction transpariétale d'un vaisseau. Cette approche a donc également été décrite dans le traitement des MV et la technique est actuellement employée pour le traitement des MV complexes au Centre des malformations et des maladies vasculaires rares du CHUV.

Why optional inferior vena cava filters are not always retrieved? A real world 19 years experience in a Swiss tertiary care university hospital.

BACKGROUND: inferior vena cava filters (IVCF) are widely used to prevent thromboembolic events in patients not suitable for anticoagulation (AC). Although new generations of filters are optional and therefore retrievable, most of them become permanent. Aim of our study was to evaluate real life IVCF management in a tertiary hospital including retrieval rates and reasons for permanent filtering. MATERIALS AND METHODS: Electronic charts from patients receiving IVCF in a Swiss university hospital, during 1999-2017, were retrospectively identified. Patients were classified in two groups, according to filter retrieval (RG) or not (NRG). Type and reasons of filter placement were assessed. Retrieval, complications, and mortality rates were calculated. Reasons of non-retrieval were analyzed. RESULTS: 920 patients received an IVCF during 1999-2017. Filters were retrieved in 372 patients (40.65%). Subjects in the NRG were significantly older, more chronically ill, and presented higher mortality rate at 12 months following filter insertion (29.60% vs. 4.30%; p < 0.001). Reasons for non-retrieval included lack of follow-up (22.34%), persistent contraindications to AC (20.51%), technical issues (17.40%), and severe morbidity with short life expectancy (17.22%). Overall, complication rates after filter placement was 18.58%. Most reported complication was filter thrombosis (15.60%). CONCLUSIONS: In a real life setting, optional IVCF are still too often left in place indefinitely. Need for a systematic follow-up to ensure prompt filter retrieval is warranted. IVCF are not retrieved mostly in chronically and more severely ill patients, likely accounting for higher mortality in these subjects.

[Intima-media thickness and carotidofemoral plaques for cardiovascular risk stratification]. / Épaisseur intima-média et plaques carotido-fémorales pour stratifier le risque cardiovasculaire.

Cardiovascular (CV) diseases are still one of the most important -killers in developed countries. In the last 40 years, great progresses have been achieved in recognizing and treating these diseases and their underlying risk factors. Risk assessment models using tradi-tional risk factors estimate the probability of a cardiovascular event in most cases and drive preventive treatment. However, these risk assessment models have weaknesses, and it is estimated that about 30 % of cardiovascular events are related to undetected risks. Many surrogate parameters have been investigated and have the potential to better predict CV risk beyond classical risk factors. The aim of this article is to assess the value of measuring the intima-media thickness and the detection of atheroma of the carotid and femoral bifurcation by ultrasound.

Dans les pays industrialisés, les maladies cardiovasculaires (CV) sont toujours une cause majeure de mortalité. Au cours des 40 ­dernières années, d'importants progrès ont permis de mieux ­reconnaître et traiter ces maladies et leurs causes. Les scores utilisant des facteurs de risque permettent d'estimer la probabilité d'un événement CV et de gérer la prévention primaire. Cependant, environ 30 % des événements CV échappent aux modèles de prédiction, raison pour laquelle de nombreux paramètres ont été étudiés afin de mieux identifier le risque au-delà des facteurs de risque CV traditionnels. L'objectif de cet article est de décrire la valeur ajoutée de la mesure de l'épaisseur intima-média (EIM) et du dépistage de plaques des bifurcations carotido-fémorales par échographie.

[Patient with lower extremity artery disease†: news in therapeutic approach]. / Artériopathie oblitérante des membres inférieurs†: nouveautés dans la thérapie médicamenteuse.

Prevalence of lower extremity artery disease (LEAD) is increasing with age, and there is a trend over the last decade towards an increase of LEAD patients. These patients are at increased risk of lower limb adverse event (MALE), but also at very high risk of major cardiovascular events (MACE). The best medical treatment, including medications, enable a reduction of this risk. Nevertheless, some patients will continue to develop MACE. New therapeutic molecules have been developed with randomized controlled trials, and showed a reduction of the -cardiovascular risk among these selected patients.

La prévalence de l'artériopathie oblitérante des membres inférieurs augmente avec l'âge, et, sur la dernière décennie, la tendance est à l'augmentation du nombre de patients atteints. Or ces patients sont à risque de développer des complications vasculaires locales, mais aussi des complications cardiovasculaires dans d'autres ­territoires. La prise en charge optimale, qui comporte un volet ­médicamenteux, permet de réduire le risque cardiovasculaire de ces patients. Chez certains, cependant, il persiste un risque résiduel. De nouvelles classes thérapeutiques ont été développées au travers d'essais cliniques contrôlés, randomisés, en double aveugle et ont permis de mettre en évidence une réduction complémentaire du risque cardiovasculaire chez ces patients.

[Best medical treatment of lower extremity arterial disease in 2018]. / Traitement médical optimal de l'artériopathie oblitérante des membres inférieurs en 2018.

Lower extremity artery disease is a very common disease, which is frequently associated with consistent disability in terms of both clinical symptoms and functioning. It is also associated with important morbidity and mortality, because of a significant increase in overall cardiovascular risk in affected patients. The establishment of an optimal medical treatment, including a careful management of the different cardiovascular risk factors through a healthy lifestyle, a regular and structured physical activity and the administration (if indicated) of antihypertensive, lipid-lowering, antidiabetic and antithrombotic drugs is a fundamental component in the clinical management of these patients and should always be considered by the clinicians facing the disease.

L'artériopathie oblitérante des membres inférieurs est une pathologie très fréquente, souvent invalidante autant sur le plan symptomatologique que fonctionnel. Elle est associée par ailleurs à une morbidité et une mortalité considérables, en raison d'une augmentation significative du risque cardiovasculaire global chez les patients atteints. L'instauration d'un traitement médical optimal, incluant une gestion attentive des différents facteurs de risque cardiovasculaire au travers d'un mode de vie sain, d'une activité physique régulière et structurée et de l'administration (si indiquée) de médicaments antihypertenseurs, hypolipémiants, antidiabétiques et antithrombotiques, représente le pilier du traitement des patients artériopathes et doit être encouragée et gérée par les médecins en charge de ces patients.

[Rare vascular diseases, building dedicated multidisciplinary specialized center]. / Maladies vasculaires rares, mise en place d'un centre multidisciplinaire spécialisé au CHUV.

Rare Vascular Diseases (RVD) encompass different types of vessel involvement. Some cause a dilation, others a weakening or tortuosity of the arterial wall, others an obstruction or excessive calcification of arterial walls. Clinical pathway of patients with RVD to diagnosis is often long and complex. Thus, in order to allow early diagnosis and coordinated multidisciplinary management and follow-up, a specialized RVD centre has been set-up at the CHUV, following the framework of the national concept of rare diseases.

Les maladies vasculaires rares (MVR) englobent différents types d'atteintes des vaisseaux. Certaines engendrent une dilatation ou une tortuosité de la paroi artérielle, d'autres une fragilisation de la paroi, d'autres encore entraînent une obstruction du vaisseau, une calcification excessive des parois, ou des malformations vasculaires. Comme pour toutes les maladies rares, le parcours des patients vers un diagnostic est souvent long et complexe. Afin de permettre un diagnostic le plus précoce possible, ainsi qu'un suivi coordonné et une prise en charge multidisciplinaire médicale et sociale, un centre des MVR a été mis en place au CHUV, dans le cadre du concept national des maladies rares.

[The treatment of venous malformations in adult patients: the role of US-guided sclerotherapy]. / Traitement des malformations veineuses chez l'adulte : rôle de la sclérothérapie échoguidée.

Venous malformations are slow flow dysplastic lesions, constituted by a vascular nest without arterial or capillary connections, more or less independent of the normal venous anatomy and circulation. In certain cases a treatment is required for symptom relief or for natural complications management. The percutaneous sclerotherapy under ultrasound guidance is increasingly used as an effective and mini-invasive option, allowing obtaining very good results with minor side effects. Several substances have been used with different efficacy and side effects rate. We review the literature and present some cases.

Les malformations veineuses sont des lésions à flux lent, constituées d'un nid vasculaire sans connexion artérielle ni capillaire, plus ou moins indépendantes du réseau veineux normal. Dans certains cas, un traitement est indiqué pour en diminuer les symptômes ou pour gérer les éventuelles complications naturelles. Le traitement par sclérothérapie percutanée sous guidage échographique se révèle une option efficace et peu invasive, permettant de diminuer le volume et d'obtenir de très bons résultats avec moins d'effets secondaires. Plusieurs substances ont été utilisées, avec différents résultats en termes d'efficacité et d'effets secondaires. Nous présentons une revue de la littérature et quelques exemples.

Radiological anatomy of upper limb arteries and their anatomical variability: implications for endovascular treatment in critical hand ischemia.

Critical hand ischemia (CHI) is a quite uncommon but highly disabling condition, generally caused by chronic occlusive arterial disease. For a correct approach to the endovascular treatment of these patients, good knowledge of the normal vascular anatomy and of the most frequently encountered vascular anatomical variations is of paramount importance. In the present paper a description of the normal vascular anatomy of the upper limb and of the most commonly encountered anatomical variations is provided, focusing on the implications for endovascular treatment of patients with CHI. Moreover, data of 151 patients with 172 critically ischemic hands treated at our institution between 2004 and 2016 are presented.