Right hand ischemia, V Alfaro

1. Víctor Julio Alfaro Obando MD1
Zoltàn Ruzca MD2
1. San Juan de Dios Hospital, San Josè, Costa Rica
2. Bàcs-Hiskun County Hospital, Kecskemèt, Hungary

2. • Nothing to disclosures

3. • KI
• Date of birth: april 8th, 1973
• Female
• DMT2
• Hyperlipidemia

4. • September 4th, 2012:
– Unstable Angina
– Coronariography: normal
– Right radial artery:
• Heparin 5000 U
• Verapamil 2.5 mg IV

5. • September 18 th, 2012:
– Parestesia
– Permanent pain right arm
– Burning
– Radial pulse was absent
– Ulnar pulse present
– Reverse allen test abnormal
• Doppler Ultrasound:
– Not detectable flow
– Ulnar flow normal
– Right radial occlusion

6. • July 16 th, 2013:
– Radial pulse absent
– Abnormal feeling on finger of right hand
– Place puncture with abnormal feeling
– Pain and weekness on right hand

7. • Lab Test May 12 th, 2016:
– Na: 142 mmol/l
– K: 4.5 mmol/l
– Cl: 106 mmol/l
– GMR more 60 ml/min/l 73 /m2
– Cr: 1.07 mg/l
– Hb: 13.8 gr/l
– HTO: 0.4 L/L
– PLT: 242 G/l
• ECG:
– Normal

8. • Right radial artery: completely occluded

9. • Retrograde way right radial artery failed because
of short puncture site
• Re-opened by superficial radial palmar arch in
retrograde way through ulnar artery due to non
visible occlusion stump
• Retrograde GW passage via Cook CX
microcatheter to safe the palmar arch
• Retrograde subintimal recanalisation with a Pilot
150 GW
• Retrograde balloon inflation:
– Invatec amphirion Deep 2.5 mmx 150 mm-150 cm

13. • Anterograde GW passage along the first GW
• Antegrade balloon predilation:
– Amphirion Deep 2.5x150 mm
– NC ballon Emerge 2.75 x 12 mm antegrade way –
distal resitatnt lesion

16. • Deployment stent Endeavour Resolute RX 3.0
x 30 mmm distal radial place
• Postdilation balloon Emerge NC 3.0 x 12 mm
intrastent

18. • Conclusion:
– Succesfull recanalisation of the right radial artery
combining antegrade and retrograd way
– ASA- clopidogrel and LMWH for 2 weeks
– Uneventfull postprocedural course – patent stent
with US

20. THANK YOU