Case report: Catheter-directed thrombolysis with ulnaris access in acute upper limb ischemia: A rare approach
Tóm tắt
Background
Acute upper limb ischemia is less common than lower limb ischemia and catheter-directed thrombolysis (CDT) is one of treatment option with safer outcome. Different kind of approach has been established for CDT, with ulnaris access as an uncommon one. In this case, we present a patient with upper limb ischemia who had successful catheter-directed thrombolysis with uncommon ulnaris approach with an excellent outcome.
Methods
A 45-years-old male patient came to the Emergency Care Unit of Hasan Sadikin General Hospital with continuous pain and numbness in the two fingers of the left hand for the past three days, accompanied with bluish discoloration and coldness on those fingers. He had history of hypertension and diabetes mellitus since 2014 with controlled treatment. On physical examination revealed normal pulsation of distal radialis and ulnaris artery, with diminished pulse oximetry result on digiti III and IV manus sinistra. Doppler examination showed monophasic flow at digitalis artery III-IV manus sinistra, with normal multiphasic flow on right hand.
Results
The patient was diagnosed with acute upper limb ischemia and planned for heparinization while preparing for catheter-directed thrombolysis with ulnaris approach. Follow-up on the next day post-thrombolysis, the bluish fingers of left hand were recovered and the patient had no complaints of pain. No complications were found after procedure. The final left-hand angiogram showed improvement of digitalis artery blood flow. The patient was discharged in a few days following procedure.
Conclusion
Catheter-directed thrombolysis with ulnaris approach is a feasible treatment option for the patient with acute upper limb ischemia. It is technically simple and safe with less bleeding risk complication. Further research is recommended to compare the risk and benefit of ulnaris approach with femoral and/or brachial approach in catheter-directed thrombolysis for acute upper limb ischemia.
