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Angioplasty of forearm arteries as a finger salvage procedure for patient with end-stage renal failure

Authors Law Y, Chan Y, Cheng S

Received 10 December 2015

Accepted for publication 10 February 2016

Published 18 April 2016 Volume 2016:9 Pages 105—109


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Rabi Yacoub

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Yuk Law, Yiu Che Chan, Stephen Wing-Keung Cheng

Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong

Abstract: Due to the relatively low metabolic demand and extensive collaterals of the upper limb, peripheral arterial disease seldom leads to tissue loss, except in patients with end-stage renal failure (ESRF), rheumatologic diseases, Raynaud’s disease, frostbites, or distal emboli. We report a case of a 51-year-old lady with ESRF who presented to our tertiary referral vascular center with infected gangrene of her right ring finger. Duplex ultrasound showed that her forearm arteries were severely diseased. Digital subtraction angiogram showed severe multilevel stenoses/occlusions in her forearm radial and ulnar arteries. These lesions were successfully angioplastized with 2 mm × 25 mm angioplasty balloon. Completion angiogram showed good radiological results with some post-dilatation spasm which improved with intra-arterial glyceryl trinitrate. The sepsis improved after revascularization, and the distal phalanx was allowed to self-demarcate with dressings and autoamputate with good clinical results. Our case illustrated that even in delayed setting, patients could still benefit from specialist vascular care with a combination of expert care and angioplasty of forearm arteries, with successful salvage of her finger.

Keywords: end-stage renal disease, finger septic gangrene, peripheral arterial disease, angioplasty, salvage

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