Author + information
- Received June 13, 2017
- Revision received June 20, 2017
- Accepted June 23, 2017
- Published online November 20, 2017.
- Tomohiko Taniguchi, MD,
- Toru Higuchi, MD,
- Junichi Tazaki, MD,
- Naritatsu Saito, MD and
- Takeshi Kimura, MD∗ ()
- ↵∗Address for correspondence:
Dr. Takeshi Kimura, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
A 46-year-old man with a 26-year history of smoking 1.5 packs of cigarettes per day was referred to our hospital because of rest pain and ischemic ulcers at the tips of the fingers of his right hand, which had been present for 2 months (Online Figure A). Antithrombotic and vasodilating agents did not improve his symptoms. He had a history of an ulcer of the tip of the ring finger of his left hand, which had healed by vasodilating agents 2 years ago. Brachial pulses were palpable, but radial and ulnar pulses were absent in his right hand. Ankle brachial indices were normal in each arm. Work-up with serological testing for autoimmune antibodies, thrombophilia, and vasculitis yielded negative results. Pre-procedural computed tomography imaging revealed occlusions of his radial and ulnar arteries (Online Figure B). Multiple occlusions of the digital branches and corkscrew collaterals were seen in echocardiography using the advanced dynamic flow mode (Toshiba, Tokyo, Japan) (Online Figure C).
A 4-F short sheath was antegradely inserted into his right brachial artery. An angiogram showed occlusion of his radial and ulnar arteries (Figure 1A, Online Videos 1 and 2). A Runthrough Ph guidewire (Terumo, Tokyo, Japan) was advanced into the occluded artery with the support of a microcatheter, Prominent Neo2 (Tokai Medical Products, Aichi, Japan). The guidewire easily crossed the occlusive lesion, which was then dilated with a 1.5 × 40-mm and 2.5 × 80-mm balloon, Crosperio RX (Terumo, Tokyo, Japan) (Figure 1B). After the dilation, the radial artery was recanalized, and no distal emboli were observed with multiple occlusions of the digital branches and corkscrew collaterals (Figures 1C and 1D, Online Videos 3 and 4). Given the clinical diagnosis of thromboangiitis obliterans, the patient was educated on the importance of smoking cessation, and treated with beraprost and cilostazol. His serious pain dramatically disappeared. Endovascular therapy could be a viable option for thromboangiitis obliterans.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 13, 2017.
- Revision received June 20, 2017.
- Accepted June 23, 2017.
- 2017 American College of Cardiology Foundation