Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series
Published 2023-06-30
Keywords
- Ischemia,
- Stents,
- Thrombectomy,
- Thromboembolism,
- Thrombosis
How to Cite
Copyright (c) 2023 Semin I.S., Ivanenko A.N., Sobolev G.A., Kiselev A.D., Kazantsev A.N., Korotkikh A.V., Chernikova I.V., Unguryan V.M.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.
Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.
Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.
Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm).
Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023.
Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.
Funding: The study did not have sponsorship.
Conflict of interest: The authors declare no conflict of interest.
Contribution of the authors
Literature review: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. Kiselev
Drafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. Sobolev
Critical revision of the article: I.S. Semin
Surgical treatment: A.N. Ivanenko, G.A. Sobolev
Final approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan
References
- Iannuzzi N.P., Higgins J.P. Acute arterial thrombosis of the hand. J Hand Surg Am. 2015;40(10):2099-2106. PMID: 26408378. https://doi.org/10.1016/j.jhsa.2015.04.015
- Kazantsev A.N., Zharova A.S., Shmatov D.V., Zakeryaev A.B., Lider R.Y., Kazantseva E.G., Bagdavadze G.S., Korotkikh A.V., Lutsenko V.A., Sultanov R.V., Lebedev O.V., Sirotkin A.A., Snopova E.V., Palagin P.D. The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure. Vascular. 2023;17085381231160933. PMID: 36867526; PMCID: PMC9988629. https://doi.org/10.1177/17085381231160933
- Черных К.П., Казанцев А.Н., Андрейчук К.А., Багдавадзе Г.Ш. Вывих коленного сустава, осложненный тромбозом подколенной артерии и острой ишемией III степени. Кардиология и сердечно-сосудистая хирургия. 2020;13(5):463-467. https://doi.org/10.17116/kardio202013051463 Chernykh K.P., Kazantsev A.N., Andreychuk K.A., Bagdavadze G.Sh. Knee dislocation complicated by popliteal artery thrombosis and acute ischemia grade III. Russian Journal of Cardiology and Cardiovascular Surgery = Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2020;13(5):463-467. (In Russ.) https://doi.org/10.17116/kardio202013051463
- Kaur P., Qaqa F., Ramahi A., Shamoon Y., Singhal M., Shamoon F., Maroules M., Singh B. Acute upper limb ischemia in a patient with COVID-19. Hematol Oncol Stem Cell Ther. 2021;14(4):348-350. PMID: 32405288; PMCID: PMC7219365. https://doi.org/10.1016/j.hemonc.2020.05.001
- Казанцев А.Н., Черных К.П., Багдавадзе Г.Ш., Заркуа Н.Э., Калинин Е.Ю., Артюхов С.В., Чикин А.Е., Линец Ю.П. Экспресс-выделение подколенной артерии по А.Н. Казанцеву при остром тромбозе на фоне течения COVID-19. Российский кардиологический журнал. 2021;26(5):4413. https://doi.org/10.15829/1560-4071-2021-4413 Kazantsev A.N., Chernykh K.P., Bagdavadze G.Sh., Zarkua N.E., Kalinin E.Yu., Artyukhov S.V., Chikin A.E., Linets Yu.P. Rapid popliteal artery release sensu A.N. Kazantsev in acute thrombosis in patients with COVID-19. Russian Journal of Cardiology. 2021;26(5):4413. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4413
- Cerşit S., Bayam E., Gündüz S., Güner A., Özkan M. Brachial embolism from mechanical mitral valve thrombosis: multimodality imaging-guided successful thrombolysis. Blood Coagul Fibrinolysis. 2018;29(4):395-398. PMID: 29406388. https://doi.org/10.1097/MBC.0000000000000696
- Cervi E., Bonardelli S., Battaglia G., Gheza F., Maffeis R., Nodari F., Maroldi R., Giulini S.M. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis. Thromb J. 2011;9:13. PMID: 21878097; PMCID: PMC3180257. https://doi.org/10.1186/1477-9560-9-13
- Turmel-Rodrigues L.A., Beyssen B., Raynaud A., Sapoval M. Thromboaspiration to treat inadvertent arterial emboli during dialysis graft declotting. J Vasc Interv Radiol. 1998;9(5):849-850. PMID: 9756079. https://doi.org/10.1016/s1051-0443(98)70404-x
- Национальные рекомендации по диагностике и лечению заболеваний артерий нижних конечностей. М., 2019. Режим доступа: https://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (дата обращения: 15.02.2023) National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities [accessed 15 February 2023]. Moscow; 2019. Availible from: https://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (In Russ.)
- Kazantsev A.N., Karkayeva M.R., Tritenko A.P., Korotkikh A.V., Zharova A.S., Chernykh K.P., Bagdavadze G.Sh., Lider R.Yu., Kazantseva Ye.G., Zakharova K.L., Shmatov D.V., Kravchuk V.N., Peshekhonov K.S., Zarkua N.E., Lutsenko V.A., Sultanov R.V., Artyukhov S.V., Kharchilava E.U., Solotenkova K.N., Zakeryayev A.B. Carotid enadrterectomy for thrombosis of the internal carotid artery in patients with COVID-19. Curr Probl Cardiol. 2022;101252. PMID: 35577077; PMCID: PMC9109971. https://doi.org/10.1016/j.cpcardiol.2022.101252
