RESUMO
OBJECTIVE: Diagnosis of chronic upper limb ischaemia is mainly clinical. Although hand perfusion can be evaluated by different non-invasive methods (e.g., digital-brachial index, digital pressures, oxygen saturation measurements, and plethysmography), these have not been standardised for the diagnosis of chronic upper limb ischaemia. Initial reports suggested that the hand acceleration time (HAT) measured by duplex ultrasound could be a useful diagnostic tool. However, the HAT has neither been properly characterised nor validated. This study aimed to provide evidence that HAT is a sensitive diagnostic tool for chronic upper limb ischaemia. METHODS: We conducted a prospective, single-centre, cross-sectional study with adult patients diagnosed with chronic upper limb ischaemia and healthy adult volunteers without cardiovascular risk factors. Hand vascular duplex ultrasound and HAT measurement were performed in four artery locations: princeps pollicis artery (HAT1), radialis indicis artery (HAT2), first common digital palmar artery (HAT3), and third common digital palmar artery (HAT4). It was also measured in the ulnar and radial arteries. Descriptive and exploratory analyses were performed between patients and healthy volunteers. RESULTS: Thirty participants were included, being 15 patients [median (SD) age: 51 (18) years; 47% women] and 15 healthy volunteers [median (SD) age: 35 (10) years; 60% women]. In total, 15 ischaemic and 30 non-ischaemic hands were analysed. Humeral artery stenosis/occlusion (n=6, 40.0%) and distal artery stenosis (n=5, 33.3%) were the main causes of ischaemia. Median (IQR) HAT measurements were significantly different between patients and healthy volunteers in the four hand arterial locations, the radial artery, and ulnar artery: HAT1: 164 (124 - 252) vs. 60 (40 - 88), p<0.001; HAT2: 176 (140 - 348) vs. 60 (36 - 80), p<0.001; HAT3: 180 (92 - 320) vs. 64 (36 - 88), p<0.001; HAT4: 180 (104 - 240) and 56 (44 - 92), p<0.001; radial artery: 156 (120 - 248) vs. 68 (55 - 76), p<0.001; ulnar artery: 152 (76 - 220) vs. 61 (48 - 76), p<0.001. CONCLUSIONS: Vascular duplex ultrasound with HAT measurement seems to be an easy-access, sensitive diagnostic tool for chronic upper limb ischemia. HAT provides valuable information on hand perfusion and may be complementary to current non-invasive methods.
RESUMO
BACKGROUND: Cryoplasty represents an alternative endovascular approach to current techniques for femoropopliteal occlusive disease treatment. Its theoretical advantage compared to angioplasty is associated with the lower appearance of recoil, dissection, and intimal hyperplasia. The aim of this study is to assess the efficacy of cryoplasty in femoropopliteal disease. MATERIAL AND METHODS: Eleven patients presenting with critical limb ischaemia (CLI) and Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II type A or B lesions in the femoropopliteal region were prospectively included in the study between November 2006 and April 2007. All patients but those with severely calcified lesions underwent cryoplasty (Polarcath Cryoplasty System(R)), and were followed up clinically and by Doppler ultrasound. Outcomes evaluated were technical success, patency at 1, 3, 6, and 12 months, mortality, limb salvage, freedom from restenosis, and freedom from occlusion rates. Statistical analysis used Kaplan-Meier curves. RESULTS: The mean age of the patients was 76 years (range, 65-89), and 81% of them were females. RISK FACTORS: 73% diabetes mellitus, 73% arterial hypertension, 64% dyslipemia, 9% smokers. Clinical: 91% CLI IV and 9% CLI III. Location of lesions: 45% popliteal; 18% superficial femoral; 18% superficial femoral and popliteal; 18% popliteal and anterior tibial. Lesion morphology: 73% stenosis, 27% occlusions. TASC II classification: 64% TASC B and 36% TASC A.Technical success: 100%. Primary, primary assisted, and secondary patency: 91%, 91% and 91% at 3 months; 63%, 82%, and 91% at 6 months; 55%, 73% and 91% at 12 months, respectively. Limb salvage and survival of 91% at 3, 6, and 12 months. CONCLUSION: Cryoplasty in the femoropopliteal region showed a good success rate, with no dissections or significant residual stenosis. However, primary patency and freedom from restenosis rates at 1 year are 55%, both demonstrating a low efficacy of the technique in this territory.