Abstract No. 35 Below-the-Elbow Transarterial Interventions for Critical Limb Ischemia in Arms without Functional Hemodialysis Accesses

To evaluate the success and safety of below-the-elbow interventions for upper extremity critical limb ischemia in arms without functional hemodialysis accesses. From June 2014 to June 2023, 22 forearm revascularizations for chronic limb ischemia were performed in 15 arms of 13 patients (6 female, 7 male) at a single center. Medical and procedural records were reviewed for baseline characteristics, procedural details, and outcomes. Clinical success was defined as improvement of ischemic symptoms, spontaneous healing of wounds, and healing of planned partial amputations. 6 interventions were performed in cases of connective tissue disease; all other cases were in patients with atherosclerotic disease. Ulceration or gangrene was present before 14 of 22 interventions. 4 interventions were performed in arms that had a previous dialysis fistula or graft that had been occluded at least 30 days prior to the intervention, and the remainder had no ipsilateral dialysis access. Balloon angioplasty was used in all cases; mechanical thrombectomy was also used in 6, and intravascular lithotripsy in 1 case. Technical success was 96% (21/22 cases). Among technically successful cases and after exclusion of 1 case due to lack of follow-up >30 days, 16 of 20 were clinically successful (80%). 9 of 20 healed a planned interphalangeal or digital amputation following revascularization; none had amputations at higher levels. Among cases with follow-up imaging, primary patency was 81% (13/16) at 1 month and 62% (8/13) at 3 months. For technical successes who had at least 6 months of follow-up, freedom from clinically driven target lesion revascularization (CD-TLR) was 71% (12/17) at 6 months. Overall freedom from CD-TLR was 65% (13/20) at an average follow-up of 16 months. There were 7 reinterventions among all cases; 2were for persistent symptoms after prior intervention; 2for new wounds on a different finger, appearing after the previous wound had healed; 1for acute thrombosis of the treated vessel; 1for return of symptoms after initial improvement; and 1 for target vessel restenosis on imaging in a high-risk patient although improvement in symptoms was noted. There were 5 minor adverse events consisting of self-limited extravasation or access site hematoma, and 1 moderate adverse event of early thrombosis of the target vessel. Below-the-elbow interventions for upper extremity critical ischemia in patients without functional hemodialysis accesses were safe with high rates of technical success, clinical success, and limb salvage.