PMC9716358_01
Patient presenting with reduced tissue perfusion involving the thenar area of the right hand.
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On examination, her right upper limb temperature was slightly lower than the contralateral temperature, her radial pulse was present, but slightly weaker than the contralateral, and perfusion was slow in the thenar region (Figure 1).
Arterial Doppler showing reduced velocity and amplitude of flow waves in the right radial artery of the wrist.
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Doppler ultrasonography was performed, showing slow blood flow through the right radial artery (Figure 2) and an absence of flow in the digital arteries.
Angiography showing no opacification of the digital arteries with contrast and opacification of muscular branches, indicating obstruction of flow.
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She was started on full anticoagulation with low molecular weight heparin (LMWH) and underwent arteriography of the right upper limb, which showed that the digital arteries of the right hand were not filling, contrast was being retained in the radial artery, and the ulnar artery was not filling, with evidence of contrast retention in the muscular arteries of the forearm (Figure 3).
Control angiography with opacification of the digital arteries by contrast after intra-arterial heparinization.
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After 24 hours under observation in an intensive care bed, the patient returned to the cath lab where angiography showed complete filling of the entire arterial network of the right upper limb (Figure 4), and her paresthesia had improved considerably.
PMC9716358_02
PMC9716358_03
Arterial Doppler image showing occlusion of the right anterior tibial artery at 23 cm from the plantar surface.
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She was examined with Doppler ultrasound, which revealed signs of occlusion in the tibial and dorsalis pedis arteries and slow perfusion along the plantar aspect (Figure 5).
Preoperative angiography showing stenosis of the dorsalis pedis and plantaris medialis arteries (from the fibular artery, originating from the tibioperoneal trunk, which does not form the posterior tibial artery).
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The tibioperoneal trunk was found not to have a bifurcation to the posterior tibial artery and there was stenosis of the dorsalis pedis and plantaris medialis arteries (Figure 6).
Postoperative control angiography showing improved appearance of the dorsalis pedis and plantaris medialis arteries.
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Percutaneous angioplasty was performed, resulting in angiographic (Figure 7) and clinical improvement.