PMC4142464_01
74-year-old presented with dry gangrene of the right index finger. Photo of the patient's right hand shows dry gangrene of the index finger (arrows).
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F1
A 74-year-old man, with a history of diabetes mellitus, hypertension, ESRD on hemodialysis, and PAD, who had previously undergone right below-the-knee amputation, presented with a few months history of dry gangrene of the right index finger [Figure 1].
74-year-old presented with dry gangrene of the right index finger. Digital subtraction angiography (DSA) of the right axillary artery shows focal moderate stenosis (arrow).
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F2
Conventional angiography through right common femoral artery access showed moderate stenosis at the right axillary artery [Figure 2], which was successfully treated with 6-mm Evercross balloon (ev3 Endovascular, Inc., Plymouth, MN, USA).
74-year-old presented with dry gangrene of the right index finger. a) DSA of the right radial artery shows a long segment of multifocal stenosis/ occlusion (arrows) and occlusion of the ulnar artery. b) Post percutaneous transluminal angioplasty (PTA) DSA shows marked improvement of flow within the radial artery. Minimal extravasation is seen at the radial puncture site (arrow), which was readily controlled by manual pressure. Proximal occlusion of the ulnar artery is seen (arrowheads). c) Two-month follow-up DSA shows recurrence of a short segment of high-grade stenosis at the level of the previously recanalized occluded vessel (arrow).
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F3
The ulnar artery was totally occluded proximally, and the radial artery showed long segments of multifocal stenosis and focal CTO [Figure 3a]. Antegrade angioplasty of the radial artery was performed using 2 mm and 3.5 mm x 8 cm x 150 cm Amphirion Deep balloons (Medtronic, Minneapolis, MN, USA), which resulted in marked improvement of flow [Figure 3b]. Radial angiogram that was performed following the procedure showed recurrence of a short segment of high-grade stenosis at the level of the recanalized occluded segment [Figure 3c].
74-year-old presented with dry gangrene of the right index finger. Photo of the patient's right hand at 4-week follow-up shows partial healing of the gangrene (arrows).
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F4
Interventional radiology clinic visit at 4 weeks showed partial healing of the gangrene [Figure 4] and improved sensation in the index finger.