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Aydın SŞ, Aksakal E, Saraç İ, Aydınyılmaz F, Özmen M, Gülcü O, Aydemir S, Kalkan K. Relationship between platelet/hemoglobin and radial thrombus in patients with coronary angiography via radial access. Biomark Med 2024. [PMID: 38197366 DOI: 10.2217/bmm-2023-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Aim: To predict the development of radial artery thrombus (RAT) in patients with radial approach coronary angiography of platelet-to-hemoglobin ratio (PHR). Materials & methods: This study was designed to evaluate the relationship between RAT and PHR. A total of 1156 patients who had coronary angiography via the transradial approach between 2021 and 2022 in the authors' center were included in the study. Results: Radial thrombus was detected in 52 (4.5%) patients. PHR was higher in the group with thrombus and was statistically significant. In the regression model, PHR was an independent predictor of the development of radial thrombus (p = 0.007). Conclusion: High PHR may be an independent predictor of the development of radial thrombus.
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Affiliation(s)
- Sidar Ş Aydın
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Emrah Aksakal
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - İbrahim Saraç
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Faruk Aydınyılmaz
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Murat Özmen
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Selim Aydemir
- Department of Cardiology, Erzurum Regional Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
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Nikizad H, Tsai D, Lookstein R, Hausman M. Catheter-Directed Thrombolysis for Acute Digit Ischemia in the Setting of Heterozygous Factor V Leiden Mutation: A Case Report and Review of Literature. JBJS Case Connect 2022; 12:01709767-202212000-00034. [PMID: 36417546 DOI: 10.2106/jbjs.cc.22.00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/01/2022] [Indexed: 11/24/2022]
Abstract
CASE We are reporting the successful treatment of a patient with a heterozygous factor V Leiden mutation who presented with spontaneous thrombotic ischemia of ring and small fingers. Microcatheter-directed administration of thrombolytics at the level of common and proper digital arteries resulted in the salvage of the ring finger to the level of the distal tuft and the entirety of the small finger. CONCLUSION Heterozygous factor V Leiden mutation is an extremely unusual etiology for thrombotic digital ischemia. This case report emphasizes the importance of correct diagnosis, timely intervention, and thrombolytic therapy using microcatheters to optimize digital rescue.
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Affiliation(s)
- Hooman Nikizad
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
| | - David Tsai
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
| | - Robert Lookstein
- Department of Diagnostic, Molecular, and Interventional Radiology at Mount Sinai Health System, New York, New York
| | - Michael Hausman
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
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3
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Jud P, Pregartner G, Berghold A, Rief P, Muster V, Gütl K, Brodmann M, Hafner F. Endovascular Thrombolysis in Hypothenar Hammer Syndrome: A Systematic Review. Front Cardiovasc Med 2021; 8:745776. [PMID: 34977173 PMCID: PMC8714786 DOI: 10.3389/fcvm.2021.745776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Hypothenar hammer syndrome (HHS) is a rare vascular disease caused by blunt trauma of the hypothenar region. The optimal therapeutic strategy remains debatably since no large comparative studies are available yet. We want to evaluate the effectiveness of intra-arterial thrombolysis on angiographic and clinical outcome parameters in patients with HHS by performing a systematic review of the existing literature. Methods: A literature search of PUBMED/MEDLINE and SCIENCE DIRECT databases was performed up to May 2021. Results: In total, 16 manuscripts with 43 patients were included in the systematic review. Intra-arterial thrombolysis led to angiographic improvement in 29 patients (67.4%) and to clinical improvement in 34 patients (79.1%). Deterioration of arterial perfusion or clinical symptoms after thrombolysis were absent. Post-interventional complications were reported in only one patient (2.3%) without any bleeding complication. Logistic regression analyses demonstrated that a combined administration of fibrinolytics and heparin was associated with a significantly improved arterial patency [OR 12.57 (95% CI 2.48–97.8), p = 0.005] without significant amelioration of clinical symptoms [OR 3.20 (95% CI 0.6–18.9), p = 0.172]. The use of rt-PA compared to other fibrinolytics and a prolonged thrombolysis duration of more than 24 h did not show statistically significant effects. Intra-arterial thrombolysis was significantly less effective in patients who had undergone thrombolysis with a delay of more than 30 days regarding clinical improvement [OR 0.07 (95% CI 0.00–0.54), p = 0.024]. Conclusions: Intra-arterial thrombolysis with a combination of fibrinolytics and heparin is an effective and safe therapeutic option in patients with acute HHS.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- *Correspondence: Philipp Jud
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Gütl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Blum AG, Gillet R, Athlani L, Prestat A, Zuily S, Wahl D, Dautel G, Gondim Teixeira P. CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings. Insights Imaging 2021; 12:16. [PMID: 33576888 PMCID: PMC7881081 DOI: 10.1186/s13244-020-00958-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.
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Affiliation(s)
- Alain G Blum
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France.
| | - Romain Gillet
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
| | | | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
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Sunagawa T, Nakashima Y, Shinomiya R, Adachi N. Digital Arterial Occlusion in the Throwing Hand of Elite Baseball Pitchers: A Report of 2 Cases Treated With Adventitial Stripping and Review of the Literature. Orthop J Sports Med 2020; 8:2325967120942064. [PMID: 32844102 PMCID: PMC7418254 DOI: 10.1177/2325967120942064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Toru Sunagawa
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakashima
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Rikuo Shinomiya
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
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Amin M, Torres A, Aguìñiga-Navarrete P, Quesada D, Jerome JP, Jones A. Acute Finger Ischemia in an Elderly Male without Risk Factors for Hypercoagulability. Clin Pract Cases Emerg Med 2020; 4:85-87. [PMID: 32064435 PMCID: PMC7012559 DOI: 10.5811/cpcem.2019.11.45224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022] Open
Abstract
Literature on ulnar artery thrombosis and acute finger ischemia is scant and usually related to underlying hypercoagulable or occlusive states, such as atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb. An elderly hypertensive male without an underlying hypercoagulable state, and in otherwise good health, presented to our emergency department with acute multi-finger ischemia, and ulnar artery and palmar arch thromboses. Given his innocuous history, this case demonstrates the importance of maintaining acute arterial thrombosis on the differential for hand pain despite the obvious propensity toward mechanical injuries in the extremities.
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Affiliation(s)
- Manish Amin
- Kern Medical Center, Department of Emergency Medicine, Bakersfield, California
| | - Angela Torres
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | | | - Daniel Quesada
- Kern Medical Center, Department of Emergency Medicine, Bakersfield, California.,LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Jason P Jerome
- Kern Medical Center, Department of Trauma Surgery, Bakersfield, California
| | - Amber Jones
- Kern Medical Center, Department of Emergency Medicine, Bakersfield, California
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7
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van der Heijden DJ, van Leeuwen MA, Ritt MJ, van de Ven PM, van Royen N. Chronic radial artery occlusion does not cause exercise induced hand ischemia. J Interv Cardiol 2018; 31:949-956. [DOI: 10.1111/joic.12552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Maarten A.H. van Leeuwen
- Department of Cardiology; Isala Heart Center; Zwolle the Netherlands
- Department of Cardiology; VU University Medical Center; Amsterdam the Netherlands
| | - Marco J.P.F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center Amsterdam; Amsterdam the Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics; VU University; Amsterdam the Netherlands
| | - Niels van Royen
- Department of Cardiology; VU University Medical Center; Amsterdam the Netherlands
- Department of Cardiology; Radboud University Medical Center; Nijmegen the Netherlands
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8
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Fung AT, Culig J, Taylor DC. Firearm-related hypothenar hammer syndrome in a police officer. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:223-225. [PMID: 30175295 PMCID: PMC6116776 DOI: 10.1016/j.jvscit.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Abstract
Hypothenar hammer syndrome (HHS) is an uncommon condition that is associated with occupational repetitive injury to the hand. The commonly associated occupations include auto mechanics, machinists, miners, and butchers or occupations requiring the worker to use the hypothenar portion of the hand as a tool. Until now, there has never been a case report of HHS secondary to firearm use. In this report, we highlight a unique presentation of firearm-related HHS.
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Affiliation(s)
- Adrian T Fung
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Culig
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David C Taylor
- Division of Vascular Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Hypothenar hammer syndrome: caused by a muscle anomaly? A case report with review of the literature. Arch Orthop Trauma Surg 2018; 138:739-742. [PMID: 29511800 DOI: 10.1007/s00402-018-2913-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 10/17/2022]
Abstract
The hypothenar hammer syndrome (HHS) is a rare entity of secondary Raynaud's phenomenon. The blunt hypothenar trauma causes a lesion of the vessel wall with a consecutive thrombosis or aneurysm of the ulnar artery at the Guyon's canal. Different risk factors are discussed such as nicotine abuse, or a muscle anomaly in the Guyon's canal. To date, there are five case reports published about muscle anomalies and HHS. We present a case of a 51-year-old shipbuilder with a unilateral HHS on his right dominant hand with a bilateral muscle anomaly. We successfully treated the patient by resection of the aneurysm without a resection of the atypical muscle.
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10
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Pruzan AN, Kaufman AE, Calcagno C, Zhou Y, Fayad ZA, Mani V. Feasibility of imaging superficial palmar arch using micro-ultrasound, 7T and 3T magnetic resonance imaging. World J Radiol 2017; 9:79-84. [PMID: 28298968 PMCID: PMC5334505 DOI: 10.4329/wjr.v9.i2.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency micro-ultrasound, 7T and 3T magnetic resonance imaging (MRI).
METHODS Four subjects (ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer (Vevo 2100, VisualSonics). Subjects’ hands were then imaged on a 3T clinical MR scanner (Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects’ hands were imaged on a 7T clinical MR scanner (Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall.
RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality (1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planar reformatting of images and allowed for less operator dependent results as compared to high frequency micro-ultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall.
CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases.
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Abstract
Ulnar-sided wrist pain can be a challenging entity for the hand surgeon and even more so in the athletic population. The authors present 8 causes of ulnar-sided wrist pain in an athlete (hook of hamate fracture, pisiform fracture, hypothenar hammer syndrome, triangular fibrocartilage complex injuries, ulnocarpal impaction syndrome, lunotriquetral ligament tears, extensor carpi ulnaris tendinitis, subluxation of extensor carpi ulnaris) and their associated imaging and treatment options.
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Affiliation(s)
| | - Ky M Kobayashi
- Colorado Center of Orthopaedic Excellence, 2446 Research Parkway, Suite 200, Colorado Springs, CO 80920, USA
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12
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Zhu Y, Li R, Lin Y, Shui M, Liu X, Chen H, Wang Y. Engineering Factor Xa Inhibitor with Multiple Platelet-Binding Sites Facilitates its Platelet Targeting. Sci Rep 2016; 6:29895. [PMID: 27432161 PMCID: PMC4949463 DOI: 10.1038/srep29895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/22/2016] [Indexed: 11/09/2022] Open
Abstract
Targeted delivery of antithrombotic drugs centralizes the effects in the thrombosis site and reduces the hemorrhage side effects in uninjured vessels. We have recently reported that the platelet-targeting factor Xa (FXa) inhibitors, constructed by engineering one Arg-Gly-Asp (RGD) motif into Ancylostoma caninum anticoagulant peptide 5 (AcAP5), can reduce the risk of systemic bleeding than non-targeted AcAP5 in mouse arterial injury model. Increasing the number of platelet-binding sites of FXa inhibitors may facilitate their adhesion to activated platelets, and further lower the bleeding risks. For this purpose, we introduced three RGD motifs into AcAP5 to generate a variant NR4 containing three platelet-binding sites. NR4 reserved its inherent anti-FXa activity. Protein-protein docking showed that all three RGD motifs were capable of binding to platelet receptor αIIbβ3. Molecular dynamics simulation demonstrated that NR4 has more opportunities to interact with αIIbβ3 than single-RGD-containing NR3. Flow cytometry analysis and rat arterial thrombosis model further confirmed that NR4 possesses enhanced platelet targeting activity. Moreover, NR4-treated mice showed a trend toward less tail bleeding time than NR3-treated mice in carotid artery endothelium injury model. Therefore, our data suggest that engineering multiple binding sites in one recombinant protein is a useful tool to improve its platelet-targeting efficiency.
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Affiliation(s)
- Yuanjun Zhu
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Ruyi Li
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Yuan Lin
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyang Shui
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Xiaoyan Liu
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Huan Chen
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Yinye Wang
- Department of Molecular and Cellular Pharmacology, Peking University School of Pharmaceutical Sciences, Beijing, China
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