ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2018 December;59(6):804-9

DOI: 10.23736/S0021-9509.17.09938-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Novel approach in using ultrasound in treating acute limb ischemia

Michael H. WHOLEY ^{1, 2} ✉, Raul G. PALACIOS ^{1, 2}, Alejandro MENDEZ-CASTILLO ^{1, 2}, Lori C. POUNDS ^{2, 3}

¹ Cardiovascular and Interventional Radiology and Vascular Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA; ² Audie L. Murphy Veterans Hospital San Antonio, San Antonio, TX, USA; ³ Vascular and Endovascular Surgery at the University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA

BACKGROUND: It is imperative to gain safe access into the occluded targeted vessel and begin treating acute extremity limb ischemia. Often the origin of the targeted native artery or bypass graft will have a flush occlusion making it difficult to cannulate. This paper looks at the novel use of portable ultrasound to evaluate the origin of the artery or bypass graft to help facilitate the start of thrombolysis.
METHODS: We reviewed our last 2 years of acute limb ischemia in our patients with high risk factors and comorbidities. We reviewed the use of ultrasound in these cases from the initial use of gaining femoral access to real time ultrasound and fluoroscopic guidance into the targeted native artery or bypass graft to begin needed thrombolysis.
RESULTS: We had 26 acute limb ischemia in 10 patients with native arterial circulation and in 16 patients with either saphenous or prosthetic bypass grafts. Ultrasound was used in gaining safe access with no complications in 22 contralateral and 2 antegrade femoral and 4 direct-graft accesses. Ultrasound was used in 6 of these cases to help gain access in the occluded graft (4 cases) and saphenous veins (2 cases). It was successful in all cases but one case which had bleeding.
CONCLUSIONS: Ultrasound is increasing in its application including acute limb ischemia with flush occlusions of native arteries and bypass grafts.

KEY WORDS: Peripheral arterial disease - Ischemia - Endovascular procedures