Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “The radial to ulnar artery loop technique”

Digital subtraction angiography (DSA) of the hand shows a patent radial artery with occlusion of the ulnar artery up to the level of the wrist.

The 0.0014-in guidewire was advanced to the radial artery and passed through the superficial Palmar arch together with the balloon catheter; then the distal part of the occluded ulnar artery was engaged and retrograde recanalization with balloon angioplasty of the Palmar arch and the ulnar artery was successfully performed with a 2 mm × 80 mm balloon catheter (“Amphirion Deep”, Invatec, Brescia, Italy). Note that the normal anatomy of the Palmar arch has been maintained during balloon dilatation.

The final angiographic result shows recanalization of the ulnar artery and direct flow to the deep Palmar arch with better visualization of digital arteries.