By Dr. Salman Arain MD
McGovern Medical School, Houston, Texas.
Those of you who know me well, know that I as keen about small (and large) vessel PAD as I am about coronary CTOs. An interesting consequence of these interests has been my foray into micro-angioplasty for refractory digital ischemia. I would like to share a case from this week…
46 year old school teacher with non healing (painful!!!) finger ulcers for 2 months. Here is the baseline angio. This is what a scleroderma hand looks like. You can see the missing flow at the tips of digits #2 and 3.
We were able to wire the proper digital branches to both digits. These vessels are too small for a balloon – so we ‘open’ them by pushing microcatheters. hese are the smallest vessels that I have intervened upon – often 1 mm or less!
Here is flow to the second digit.
This is the hand immediately after the intervention. Note the cyanosis and swelling…
But her hand and finger mobility is back!!
This day 2 – on Flolan.
And this day 3. The wounds are drying up and the color is almost normal. The fingers sre fully mobile and not tender.
GlobeMedic 