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Journal articles on the topic 'Ischemie digitale'

Author: Grafiati

Published: 4 June 2021

Last updated: 4 February 2022

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1

Marvi, Umaima, and Lorinda Chung. "Digital Ischemic Loss in Systemic Sclerosis." International Journal of Rheumatology 2010 (2010): 1–7. http://dx.doi.org/10.1155/2010/130717.

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Digital ischemic loss is a cause of significant morbidity in patients with systemic sclerosis (SSc). Microvascular disease with intimal proliferation and luminal narrowing of small digital arteries, as well as macrovascular disease with narrowing or occlusion of larger digital arteries, contribute to the perfusion defects involved in digital ischemic loss. Immediate clinical evaluation and treatment are mandatory at the onset of critical digital ischemia to prevent digital loss. Hospitalization for medical therapies including intravenous prostacyclin therapy should be considered for all SSc patients who present with critical digital ischemia. Surgical interventions are typically reserved for patients who fail medical therapies and for those with late stage, necrotic tissue. This paper summarizes the current knowledge regarding the risk factors, pathogenesis, evaluation, and treatment of digital ischemic loss in SSc.

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2

Hamed, Esmael Ali. "Distal Peri-Arterial Sympathectomy: The Over-Ratted Option in Management of Peripheral Cyanotic Disorders." Journal of Clinical Case Studies Reviews & Reports 2, no. 4 (August 31, 2020): 1–2. http://dx.doi.org/10.47363/jccsr/2020(2)139.

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Background: Digital ischemia in upper and lower extremity, with ulceration and gangrene can be a manifestation of Raynaud’s phenomenon (RP). The early manifestation of Raynaud’s may be informed of ischemic pain and numbness, cold intolerance and in severe cases manifested as ulceration and gangrene. Aim of the study: to evaluate the results of digital sympathectomy in cases of severe ischemia of digits manifesting as digital ulceration and ischemic pain refractory to medical treatment. Patient and method: Distal sympathectomy of the ulnar and radial arteritis of the affected limb. Results: The patient developed dramatic improvement of symptoms, we were surprised for patient satisfaction and appreciation. We touched firmly the affected finger and the patient was smiling. On follow up, no return of annoying symptoms. Conclusion: Distal sympathectomy is a safe and perfect solution in management of peripheral cyanotic disorders, Raynaud’s, causalgia, digital ischemia.

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3

Küçükşahin, Orhan, Aşkın Ateş, Alexis K. Okoh, Emre Kulahcioglu, Murat Turgay, and Gülay Kınıklı. "Treatment Resistant Severe Digital Ischemia Associated with Antiphospholipid Syndrome in a Male Patient with Systemic Sclerosis." Case Reports in Rheumatology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/291382.

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We report the case of a male patient with limited cutaneous systemic sclerosis (SSc) that was complicated with severe digital ischemia, resistant to medical treatment. Due to the lack of treatment response, further laboratory and imaging studies were conducted. Findings were compatible with antiphospholipid syndrome and oral warfarin was added to the treatment regimen. After successful anticoagulation no further recurrences of digital ischemia were seen. An underlying etiology in SSc patients with treatment resistant digital ischemic necrosis should be suspected for accompanying antiphospholipid syndrome (APS).

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4

Engwall, Abigail J., Tannur C. Oakes, Mohammad Torabi, Kyle J. Schank, Benjamin W. Kuhns, Pam Haan, and James H. W. Clarkson. "Ischemia Developing in a Fibrotic Finger Following the Use of Anesthetic With Epinephrine, Salvaged by Hyperbaric Oxygen Therapy." Plastic Surgery Case Studies 7 (January 1, 2021): 2513826X2110075. http://dx.doi.org/10.1177/2513826x211007582.

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Background: The use of epinephrine for hand surgery has been rising over the past decade following the popularization of Wide Awake Local Anesthetic No Tourniquet (WALANT). Traditional teaching from the 20th century forbade the use of epinephrine claiming it could induce digital ischemia, yet trial data now contradicts this assumption. Purpose: Digital ischemia after epinephrine injection cases are important to report because epinephrine is being used increasingly in finger anesthesia. We wish to communicate to a growing number of hand surgeons who may be new to WALANT that epinephrine may have adverse effects in a fibrotic poorly perfused environment which is salvageable by hyperbaric oxygen therapy (HBOT). Case presentation: A 22-year-old male sustained a crush injury resulting in right index phalanx fracture. Acute open reduction with K wire fixation was performed under WALANT using 1% lidocaine with 1:100,000 epinephrine. After removal of wires, he was found to require elective open reduction and internal fixation with bone graft for delayed union, which was performed tension free using general anesthetic plus bupivacaine and 1:200,000 epinephrine. Despite mild congestion, phentolamine was not acutely administered when it might have been justified. The patient presented to the clinic five days later with blistering ischemic necrosis of the pulp, which was salvaged by HBOT. Summary: This case of digital ischemia following a crush injury with fibrotic scarring treated with lidocaine and epinephrine is reported as a warning to other hand surgeons performing WALANT. Epinephrine should be used with caution for digital blocks associated with scarred or fibrotic tissue and phentolamine should be used to reverse acute ischemia. HBOT can still salvage compromised tissue once the subacute process of ischemic necrosis has begun.

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5

Peters, Blair R., Tianyi Liu, Edward Buchel, Leif Sigurdson, Thomas Hayakawa, and Avinash Islur. "Arterialization of the Venous System for Acute and Chronic Ischemia of the Hand: A Case Series With Prospective Duplex Ultrasound Assessment." HAND 15, no. 2 (November 12, 2018): 170–76. http://dx.doi.org/10.1177/1558944718810873.

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Background: Ischemia of the hand is a debilitating condition. In many cases, the cause of ischemia is diffuse atherosclerosis with no distal vessels available for bypass. In these situations, options are limited to restore perfusion, and there is a potential role for arterialization of the venous system to relieve ischemic pain and avoid amputation. Methods: This is a retrospective review of all patients at our institution who underwent arterialization of the venous system between 2010 and 2014 by 4 surgeons for acute or chronic ischemia of the upper extremity not amenable to bypass procedures. Indications, preoperative and postoperative findings, and the requirement for future digital amputations were recorded. The patients were then evaluated prospectively for the patency of arteriovenous anastomosis and the pattern of perfusion by duplex ultrasound studies. Results: Eight patients with 10 upper extremities underwent arterialization of the venous system. All patients with chronic ischemia went on to heal their ischemic ulcerations with relief of rest pain and avoided amputation. Eight upper extremities had arterial Doppler and duplex ultrasound signals showing arterialized dorsal veins demonstrating flow from the dorsal veins heading volar via the intrinsic compartments into the digital arteries. Conclusions: This study illustrates the successful use of arterialization of the venous system of the hand in both acute and chronic hand ischemia. It reports on prospective imaging and duplex ultrasound studies confirming patency of the anastomosis and objective evidence of distal arterial flow. Based on our experience, we believe that arterialization of the venous system may provide an effective salvage option in the setting where no distal bypass is available.

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6

Kapoor, John R., Roger Kapoor, and Themistocles L. Assimes. "Digital ischemia." Journal of Cardiovascular Medicine 9, no. 12 (December 2008): 1285–86. http://dx.doi.org/10.2459/jcm.0b013e3283168d50.

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7

Han, Zhong Chao, Pingping Huang, and Shangzhu Li. "Autologous Peripheral Blood Stem Cell Implantation as Therapeutic Angiogenesis for Severe Limb Ischemia Autologous Peripheral Blood Stem Cell Implantation as Therapeutic Angiogenesis for Severe Limb Ischemia." Blood 104, no. 11 (November 16, 2004): 4174. http://dx.doi.org/10.1182/blood.v104.11.4174.4174.

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Abstract It is estimated that 100 million individuals suffer from severe limb ischemia worldwide. Here, we report a novel therapy for severe limb ischemia by transplanting autologous peripheral blood stem cells (PBSCs). Thirty patients with different limb ischemia were enrolled and randomized to either stem cell injection or standard therapy in the study. The patients in the transplant group received intramuscular injections of autologous PBSCs collected after G-CSF-induced stem cell mobilization. Lower limb pain, ulcer repair and wound healing and blood perfusion were improved in the cell treated group. All cell treated patients achieved successful limb salvage. Analysis by digital subtraction angiography demonstrated the formation of new collateral vessels in the ischemic limbs of transplanted patients after cell injection. In contrast, no significant improvement was observed in the control patients. These results provide pilot evidence indicating that transplantation of autologous PBSCs is a simple and effective therapeutic angiogenesis for limb ischemia. To determine the mechanism of action, several animal experiments were performed by transplanting human PBSCs via tail vein into nude mice. It was found that the transplanted cells survived and incorporated into capillary networks in murine ischemic limb. Laser Doppler Perfusion Image (LDPI) and histological analysis revealed that the transplantation of human PBSCs augmented blood flow and neovascularization in the ischemic hindlimb, ameliorated necrosis and improved limb salvage. Our results demonstrate that PBSCs are excellent cell population capable of augmenting neovascularization.

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8

Raul Soberón, José, Scott F. Duncan, and W. Charles Sternbergh. "Treatment of Digital Ischemia with Liposomal Bupivacaine." Case Reports in Anesthesiology 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/853243.

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Objective. This report describes a case in which the off-label use of liposomal bupivacaine (Exparel) in a peripheral nerve block resulted in marked improvement of a patient’s vasoocclusive symptoms. The vasodilating and analgesic properties of liposomal bupivacaine in patients with ischemic symptoms are unknown, but our clinical experience suggests a role in the management of patients suffering from vasoocclusive disease.Case Report. A 45-year-old African American female was admitted to the hospital with severe digital ischemic pain. She was not a candidate for any vascular surgical or procedural interventions. Two continuous supraclavicular nerve blocks were placed with modest clinical improvement. These effects were also short-lived, with the benefits resolving after the discontinuation of the peripheral nerve blocks. She continued to report severe pain and was on multiple anticoagulant medications, so a decision was made to perform an axillary nerve block using liposomal bupivacaine (Exparel) given the compressibility of the site as well as the superficial nature of the target structures.Conclusions. This case report describes the successful off-label usage of liposomal bupivacaine (Exparel) in a patient with digital ischemia. Liposomal bupivacaine (Exparel) is currently FDA approved only for wound infiltration use at this time.

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9

Neal, Joseph M. "Iatrogenic digital ischemia." Annals of Emergency Medicine 15, no. 3 (March 1986): 382–83. http://dx.doi.org/10.1016/s0196-0644(86)80602-3.

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10

Rosenberg, Jacob M., and Ralph Rosenberg. "Bilateral Digital Ischemia." New England Journal of Medicine 370, no. 12 (March 20, 2014): 1148. http://dx.doi.org/10.1056/nejmicm1309192.

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11

Cires, Rafael S., and Susana V. Maya. "Severe Digital Ischemia." New England Journal of Medicine 357, no. 1 (July 5, 2007): 52. http://dx.doi.org/10.1056/nejmicm065845.

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12

Pomposelli, Frank. "Arterial Imaging in Patients with Lower-extremity Ischemia and Diabetes Mellitus." Journal of the American Podiatric Medical Association 100, no. 5 (September 1, 2010): 412–23. http://dx.doi.org/10.7547/1000412.

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Precise comprehensive imaging of arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental, with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified, and patients with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography, contrast-enhanced magnetic resonance angiography, and, more recently, computed tomographic angiography have been used as imaging modalities in lower-extremity ischemia. Each modality has specific advantages and shortcomings in this patient population, which are summarized and contrasted in this review. (J Am Podiatr Med Assoc 100(5): 412–423, 2010)

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13

Calloni, Renato Luis, Bruno Costamilam Winkler, Guilherme Ricci, Marcos Giacomelli Poletto, Wagner Martins Homero, Eduardo Pretto Serafini, and Oly Campos Corleta. "Transient middle cerebral artery occlusion in rats as an experimental model of brain ischemia." Acta Cirurgica Brasileira 25, no. 5 (October 2010): 428–33. http://dx.doi.org/10.1590/s0102-86502010000500008.

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PURPOSE: To assess a rat model of cerebral ischemia induced by occlusion of the middle cerebral artery and its effect on the area of cerebral infarction. METHODS: Brain ischemia was induced in 52 male Wistar rats by introduction of a 3-0 nylon suture into the middle cerebral artery for either 90 (n=28) or 120 (n=24) minutes. Ischemic injury volume was determined by TTC staining, digital photography and analysis with the Image J software. Statistical analysis employed Student’s t test and the Mann-Whitney U test. RESULTS: The groups were similar in terms of weight (p=0.59). The length of thread inserted was 14.7 mm in the 90 min group and 20.2 mm in the 120 min group (p=0.37). Ischemic injury was detected in 11 animals (39%) after 90 min and 11 (45%) after 120 min (p=0.77). In animals exhibiting injury, filament length was 16.1±11 mm (90 min) vs. 21.9±7.4 mm (120 min) (p=0.15). The mean infarction zone volume was greater after 120 (259.2 mm³) than after 90 min (162.9 mm³) (p=0.04). The neurological deficit score for the 90 and 120 min groups was 2.0 and 2.4, respectively (p=0.84). CONCLUSION: The experimental model induced significant ischemic cerebral injury in both groups.

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14

Majumder, Sabbiha Nadia, Abdul Kader Sheikh, Mehjabeen Jahangir, and Romana Chowdhury. "Moyamoya Disease Presenting as Ischemic Stroke Following Heamorrhagic Strokein a 46-year-old Man: A Case Report." Bangladesh Medical Journal 48, no. 1 (October 23, 2019): 54–58. http://dx.doi.org/10.3329/bmj.v48i1.50193.

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Moyamoya is a rare cerebrovascular disease of unknown etiology. It can affect both children and adults. Ischemic symptoms are common in younger age while adults presents with intracranial hemorrhage. Cerebral ischemia after hemorrhage within a narrow time frame or simultaneous presentation with both hemorrhage and ischemia in the same clinical setting is a rare encounter. Diagnosis is confirmed by doing cerebral angiogram. Here, we report a case of 46-year-old man who presented with hemiparesis and imaging of brain showed ishaemic stroke initially and subsequently he also developed haemorrhagic stroke. Later, magnetic resonance imaging and digital substraction angiogram of brain confirmed Moyamoya disease. He was managed conservatively with significant improvement of his hemiparesis. Bangladesh Med J. 2019 Jan; 48 (1): 54-58

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15

Berge, Keith H., William L. Lanier, and Paul D. Scanlon. "Ischemic Digital Skin Necrosis." Anesthesia & Analgesia 67, no. 7 (July 1988): 712???713. http://dx.doi.org/10.1213/00000539-198807000-00023.

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16

Attal, R., I. Lazareth, G. Angelopoulos, and P. Priollet. "Ranibizumab and digital ischemia." JMV-Journal de Médecine Vasculaire 43, no. 1 (February 2018): 65–69. http://dx.doi.org/10.1016/j.jdmv.2017.11.006.

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17

Radwan, Y., T. Gunderson, C. S. Crowson, D. Liedl, K. J. Warrington, P. Wennberg, and A. Makol. "OP0177 PRESENCE AND SEVERITY OF DIGITAL OCCLUSIVE ARTERIAL DISEASE PREDICTS DIGITAL ISCHEMIC COMPLICATIONS IN SYSTEMIC SCLEROSIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 106.2–106. http://dx.doi.org/10.1136/annrheumdis-2021-eular.924.

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Background:Vasculopathy is a key feature of systemic sclerosis (SSc), manifesting clinically as Raynaud’s phenomenon (RP) with or without digital ischemia. Laser doppler flowmetry (LDF) with thermal challenge is a safe, noninvasive and reproducible technique to detect digital occlusive arterial disease (DOAD) with a high sensitivity and specificity of >90% (1).Objectives:To study the prevalence and clinical correlates of DOAD assessed by LDF in patients with SSc referred for evaluation of RP at a tertiary referral center.Methods:Medical records of all patients with SSc meeting ACR/EULAR 2013 classification criteria that underwent LDF between Jan 2001-Dec 2018 at our institution were retrospectively reviewed to abstract the presence or absence of DOAD. The presence of DOAD on LDF was confirmed if pre- and post-warming skin blood flow was ≤206 arbitrary units. Severity of DOAD was assessed based on number of digits involved. Risk factors associated with presence of DOAD in SSc, and correlation between presence and severity of DOAD with digital ischemic complications were studied.Results:304 patients with SSc (mean age 57.1 ± 3.3 y, 81% females, 93% Caucasians) underwent LDF during the study period. Median time between SSc diagnosis and performing LDF was 12.9 months. Majority of patients with SSc had limited cutaneous SSc (lcSSc) (79.6%) and 64.1% had a positive SSc specific antibody.On LDF with thermal challenge, presence of DOAD was noted in 243 (79.9%) patients, of whom 78.6% had lcSSc, 42.4% had a centromere antibody (Ab), 17.3% had a Scl-70 Ab, 53.5% had interstitial lung disease, 36.6% had pulmonary arterial hypertension, and 73.3% had gastrointestinal dysmotility (GID). Of 159 patients with DOAD who also had a nailfold capillaroscopy, 70.4% had abnormalities. Large vessel occlusive disease was significantly higher in patients with DOAD in comparison to those without DOAD (29.2% vs 16.4%; p: 0.04). After adjusting for age and sex, GID (OR: 2.73 [95%CI 1.52-4.92]) and telangiectasia (OR: 2.83 [95%CI 1.23-6.40]) were significantly associated with DOAD.Digital ischemic complications among patients with SSc with DOAD were significantly higher than among those without DOAD (79.8% vs 41.0% had digital ulcers, 53.9% vs 26.2% had pitting/scars, 31.3% vs 8.2% had gangrene/amputation; p <0.001). (Figure 1) Increasing severity of DOAD was associated with a statistically significantly higher incidence of digital ischemic complications as presented in Table 1.Figure 1.Correlation between the presence of digital occlusive arterial disease (DOAD) and digital ischemic complications in systemic sclerosisTable 1.Logistic regression models for association of digital ischemic complications and severity of digital occlusive arterial diseaseDigital InvolvementComplicationOdds Ratio (OR)Reflects “digits vs. 0”ORCI 95%Digital UlcerUnit Increase1.281.19-1.391-22.110.927-4.923-75.572.84-11.28-1010.94.98-25.4Digital Tip Pitting/ScarsUnit Increase1.171.10-1.261-21.920.803-4.613-72.621.35-5.288-105.452.72-11.4Digital Gangrene/AmputationUnit Increase1.261.16-1.371-21.360.317-5.483-74.101.62-12.68-109.053.60-27.7Any Digital InvolvementUnit Increase1.351.24-1.491-22.981.27-7.303-76.163.08-12.78-1018.57.46-53.2Conclusion:This is the largest single center study to describe the prevalence and predictors of DOAD on LDF in a well-defined cohort of patients with SSc.The high prevalence of DOAD on LDF noted in SSc-RP make it a valuable tool not only for evaluation of vasculopathy in SSc but also to distinguish it from Primary RP. The presence and severity of DOAD strongly correlates with digital ischemic complications and can be used as a guide to counsel patients and determine the aggressiveness of therapeutic interventions. Our study underscores the significance of LDF as a reliable non-invasive modality to detect DOAD and a prognostic tool to identify patients at highest risk of digital ischemic complications.References:[1]Mahe G et al. J Vasc Surg. 2014 Apr;59(4):1051-1057.e1Disclosure of Interests:None declared

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18

Niimi, Yosuke, Hiroshi Ito, Karin Ikeda, Miho Kirita, Junji Hishiyama, and Hiroyuki Sakurai. "Digital Artery Massage for Improving Ischemia after Distal Digital Replantation Surgery." Journal of Reconstructive Microsurgery Open 03, no. 01 (January 2018): e25-e27. http://dx.doi.org/10.1055/s-0038-1642627.

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AbstractDistal digital replantation is frequently associated with arterial thrombosis and/or spasm, leading ischemia in the replanted tissue. This report introduced a rescue technique for ischemia after distal digital replantation without reanastomosis. Two males, 64 and 51 years old, underwent Ishikawa subzone II finger amputations. Microsurgical replantations with vein grafts were performed. Intraoperatively, heparin and urokinase through intra-arterial infusion were given for one week. At 40 to 48 hours after surgeries, the replanted digits developed ischemia; massaging digital arteries at the proximal phalanx regions with running warm water was immediately initiated and ischemia was improved. In both cases, the replanted tissues were rescued, though a partial necrosis requiring full-thickness skin grafting was found in one case. This massage was easily, safely, and effectively performed without complications and was applicable in cases with ischemia after distal digital replantation, especially where reanastomosis was unfeasible.

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19

Prandini, Mirto Nelso, Santino Nunes Lacanna, Paulo Roberto Valente, and João Norberto Stavale. "Regional mild hypothermia in the protection of the ischemic brain." Acta Cirurgica Brasileira 17, no. 4 (August 2002): 232–35. http://dx.doi.org/10.1590/s0102-86502002000400006.

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Objective: To demonstrate that mild hypothermia can be a protective element when an ischemic onset occurs in rabbit brains. Methods: A rabbit model of focal ischemia was used to test the protection provided by mild hypothermia regionally produced by means of the placement of ice bag on the scalp of a hemicranium which has had previously its bone removed. Twenty New Zealand White rabbits were divided into two groups as follows: (A) a control group where an ischemic lesion was produced by coagulation of the middle cerebral artery and (B) a brain protected group where mild hypothermia was provided during 80 to 100 minutes after the same ischemic lesion. The brains slices were stained with 2,3,5-Triphenyletrazolium (TTC). The sections were photographed with a digital camera and the infarct volume was measured through a computer program. Results: The average of infarct volume was 70.53 mm³ in the control group. In the protected group, the average of infarct volume was 41,30 mm³ only in five animals. Five animals of this group did not demonstrate macroscopically and microscopically infarct area. Conclusions: We concluded that mild hypothermia regionally produced may protect ischemic brains of rabbits.

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20

Wang, Chao-Hung, Wen-Jin Cherng, Ning-I. Yang, Chia-Ming Hsu, Chi-Hsiao Yeh, Yii-Jenq Lan, Jong-Shyan Wang, and Subodh Verma. "Cyclosporine increases ischemia-induced endothelial progenitor cell mobilization through manipulation of the CD26 system." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 294, no. 3 (March 2008): R811—R818. http://dx.doi.org/10.1152/ajpregu.00543.2007.

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Cyclosporin A (CsA) improves the success rate of transplantation. The CD26/dipeptidylpeptidase IV (DPP IV) system plays a critical role in mobilizing endothelial progenitor cells (EPCs) from bone marrow. This study investigated whether CsA manipulates CD26/DPP IV activity and increases EPC mobilization. C57BL/6 mice were divided into control and CsA-treated groups. Before and after hindlimb ischemia was induced, circulating EPC number and serum levels of different cytokines were measured. Compared with the controls, CsA treatment significantly increased the blood levels of stroma-derived factor-1α and stem cell factor after ischemic stress ( P < 0.001). The CsA group displayed a significant increase in the number of circulating EPCs (sca-1+KDR+ and c-kit+CD31+ EPCs, both P < 0.05). In vivo, CsA caused a significant increase in the numbers of EPCs incorporated into the Matrigel and ischemic limbs ( P < 0.05). In the peripheral blood, CsA significantly decreased CD26+ cell numbers and attenuated the plasma CD26/DPP IV activity ( P < 0.001). Furthermore, short-term CsA treatment significantly improved the perfusion of ischemic limbs and decreased the spontaneous digital amputation rate. In summary, CsA manipulates the mobilization of EPCs into the circulation via the CD26/DPP IV system. Short-term CsA treatment has beneficial effects on angiogenesis of ischemic tissues.

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21

JOHANSEN, KAJ, TERENCE MURPHY, EDWARD PAVLIN, and DANIEL LEDBETTER. "Digital ischemia complicating pneumococcal sepsis." Critical Care Medicine 19, no. 1 (January 1991): 114–15. http://dx.doi.org/10.1097/00003246-199101000-00025.

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22

Le Besnerais, Maëlle, Sébastien Miranda, Nicole Cailleux, Nicolas Girszyn, Isabelle Marie, Hervé Lévesque, and Ygal Benhamou. "Digital Ischemia Associated With Cancer." Medicine 93, no. 10 (August 2014): e47. http://dx.doi.org/10.1097/md.0000000000000047.

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23

Sugawara, Makoto, Toshihiko Ogino, Akio Minami, and Sechi Ish. "Digital ischemia in baseball players." American Journal of Sports Medicine 14, no. 4 (July 1986): 329–34. http://dx.doi.org/10.1177/036354658601400417.

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24

Woei-A-Jin, F. J. Sherida H., Jouke T. Tamsma, Laurence V. Khoe, Wietske C. E. den Hartog, Jan J. Gerritsen, and Anneke Brand. "Lymphoma-associated paraneoplastic digital ischemia." Annals of Hematology 93, no. 2 (June 10, 2013): 355–57. http://dx.doi.org/10.1007/s00277-013-1806-1.

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25

Namdari, Surena, Arnold-Peter C. Weiss, and Wilfred I. Carney. "Palmar Bypass for Digital Ischemia." Journal of Hand Surgery 32, no. 8 (October 2007): 1251–58. http://dx.doi.org/10.1016/j.jhsa.2007.07.003.

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26

Cooney, William P. "Palmar Bypass for Digital Ischemia." Journal of Hand Surgery 33, no. 4 (April 2008): 616–17. http://dx.doi.org/10.1016/j.jhsa.2008.01.027.

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Kazanji, Noora, John Falatko, Saroj Neupane, and Gampala Reddy. "Calciphylaxis presenting as digital ischemia." Internal and Emergency Medicine 10, no. 4 (December 16, 2014): 529–30. http://dx.doi.org/10.1007/s11739-014-1172-6.

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28

McClure, Melissa M., Art Riddle, Mario Manese, Ning Ling Luo, Dawn A. Rorvik, Katherine A. Kelly, Clyde H. Barlow, et al. "Cerebral Blood Flow Heterogeneity in Preterm Sheep: Lack of Physiologic Support for Vascular Boundary Zones in Fetal Cerebral White Matter." Journal of Cerebral Blood Flow & Metabolism 28, no. 5 (December 19, 2007): 995–1008. http://dx.doi.org/10.1038/sj.jcbfm.9600597.

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Periventricular white matter (PVWM) injury is the leading cause of neurologic disability in survivors of prematurity. To address the role of ischemia in PVWM and cerebral cortical injury, we hypothesized that immaturity of spatially distal vascular ‘end zones’ or ‘border zones’ predisposes PVWM to greater decreases in cerebral blood flow (CBF) than more proximal structures. We quantified regional CBF with fluorescently labeled microspheres in 0.65 gestation fetal sheep in histopathologically defined three-dimensional regions by post hoc digital dissection and coregistration algorithms. Basal flow in PVWM was significantly lower than in gyral white matter and cortex, but was equivalent in superficial, middle, and deep PVWM. Absolute and relative CBF (expressed as percentage of basal) did not differ significantly during ischemia or reperfusion between PVWM, gyral white matter, or cortex. Moreover, CBF during ischemia-reperfusion was equivalent in three adjacent PVWM levels and was not consistent with the magnitude of severity of PVWM injury, defined by TUNEL (terminal deoxynucleotidyltransferase-mediated dUPT nick end labeling) staining. However, the magnitude of ischemia was predicted by the severity of discrete cortical lesions. Hence, unlike cerebral cortex, unique CBF disturbances did not account for the distribution of PVWM injury. Previously defined cellular maturational factors, thus, appear to have a greater influence on PVWM vulnerability to ischemic injury than the presence of immature vascular boundary zones.

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Lanterna, Luigi A., Carlo Brembilla, Antonio Signorelli, Paolo Gritti, Emanuele Costi, Gianluigi Dorelli, and Claudio Bernucci. "STA-MCA Bypass as a “Bridge” to Pituitary Surgery in a Patient with an Adenoma Occluding the Internal Carotid Artery: Case Report and Review of the Literature." Case Reports in Neurological Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/359586.

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Occlusion of the intracranial internal carotid artery (ICA) by a pituitary adenoma with resulting cerebral ischemia is a very rare but devastating occurrence. The authors present a case in which a condition of symptomatic ICA occlusion due to a giant pituitary adenoma was successfully treated using a preliminary extraintracranial bypass as a “bridge” to the tumor removal. A 52-year-old patient presented with a minor stroke followed by pressure-dependent transient ischemic attacks consistent with a condition of hypoperfusion. MR imaging and a digital subtraction angiography revealed a pituitary adenoma occluding the ICA on the right side. He underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass with the aim of revascularizing the ischemic hemisphere and reducing the risk of perioperative stroke or stroke evolution. The patient was subsequently operated on to remove the adenoma through a transsphenoidal approach. The postoperative course was uneventful and the patient has suffered no further ischemic events. When there are no emergency indications to decompress the optical pathways but the patient is at risk of impending stroke because of ICA occlusion, a two-step strategy consisting of a bypass and subsequent removal of the pituitary adenoma may be a valuable option.

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Jung, Sung Min, and Heungman Jun. "Recurrent thrombosis of splanchnic and lower extremity arteries with essential thrombocythemia." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1988007. http://dx.doi.org/10.1177/2050313x19880079.

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Essential thrombocythemia is a myeloproliferative neoplasm characterized by platelet aggregation and thrombosis. Clinically, essential thrombocythemia increases the risk of both thrombosis and bleeding. Essential thrombocythemia is more involved in micro- and small-sized arteries than in large arteries. Many essential thrombocythemia patients exhibit various symptoms, including microvascular thrombosis with acute coronary disease, digital ischemia, and transient ischemic attack. This study reports a rare case of recurrent thrombosis in relatively large vessels including splanchnic, lower extremity arteries, and aorta in essential thrombocythemia. A 70-year-old woman was admitted to the emergency room with abdominal pain and fever for a day. The patient underwent three operations due to recurrent arterial thrombosis of superior mesenteric, splenic, aorta, and lower extremities. She had recurrent diarrhea and acute kidney injury because of short bowel syndrome after extensive bowel resection. In conclusion, essential thrombocythemia patients aged >60 years and who have risk factors such as history of major ischemic events or severe leukocytosis must be careful of thrombosis of the medium- and large-sized arteries, including splanchnic and lower extremity arteries.

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Hasan, Md Nazmul, Md Abdur Rahim, Quazi Mamtaz Uddin Ahmed, Md Syedul Islam, Md Atikur Rahman, and Md Shamim. "Essential thrombocythemia presenting as digital ischemia." Bangabandhu Sheikh Mujib Medical University Journal 10, no. 3 (September 4, 2017): 175. http://dx.doi.org/10.3329/bsmmuj.v10i3.33698.

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<p class="Abstract">Essential thrombocythemia is a myeloproliferative disease and is characterized by increased production of platelet and increased megakaryocytes in the bone marrow. Though platelets are high in number but may not function normally and can cause hyperviscosity syndrome and blockage of the blood vessels and other complications. Here, we report two cases of essential thrombocythemia, presented with pain in hands and feet and one with digital infarction. Both the patients had headache and vertigo.</p>

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Torre, J. "Ulnar artery aneurysm with digital ischemia." Vascular Medicine 4, no. 3 (August 1, 1999): 143–45. http://dx.doi.org/10.1191/135886399668799120.

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Ibn Mujtaba, Salman, Aljoharah Alameel, Bashayer Hamad, and Taimur Salar Butt. "Digital Ischemia From Accidental Epinephrine Injection." Emergency Medicine 50, no. 5 (May 1, 2018): 113–17. http://dx.doi.org/10.12788/emed.2018.0090.

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Sargin, Serdar, Aziz Atik, Gökhan Meric, and Ali E. Ulusal. "Leech treatment for prolonged digital ischemia." Current Orthopaedic Practice 26, no. 1 (2015): 81–83. http://dx.doi.org/10.1097/bco.0000000000000183.

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35

Leclercq, P., and B. Lambermont. "Morphine abuse and bilateral digital ischemia." Canadian Medical Association Journal 181, no. 12 (October 13, 2009): 927. http://dx.doi.org/10.1503/cmaj.081281.

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Karabacak, Kubilay, Murat Kadan, Erkan Kaya, Baris Durgun, Gokhan Arslan, Suat Doganci, Cengiz Bolcal, and Ufuk Demirkilic. "Oxaliplatin Induced Digital Ischemia and Necrosis." Case Reports in Vascular Medicine 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/248748.

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Introduction. Digital ischemia is a rare complication of several chemotherapeutic medications. We aimed to present a patient with digital ischemia, secondary to a new generation chemotherapeutic drug, oxaliplatin.Case Report. 62-year-old woman presented to our department with severe pain, paresthesia, and distal acrocyanosis on her right hand fingertips. Her complaints started five days after the third cycle of a chemotherapy protocol consisting of 5-fluorourasil (5-FU), folinic acid, and oxaliplatin due to advanced colon carcinoma. On physical examination, hemorrhagic and partly ulcerative lesions were detected at her right hand fingertips. Radial and ulnar pulses were absent at affected side. Digital subtraction angiography revealed severe vascular resistance in the affected extremity. Iloprost trometamol treatment was started with the dosage of 1 ng/kg/min. In addition, low-molecule-weight heparin was used for preventing possible microemboli. Symptomatic relief was provided after five days, and patient was discharged on 7th day of treatment.Discussion. The pathogenesis of oxaliplatin induced vascular toxicity remains unclear. Endothelial damage, increased adherence of platelets, deposition of immune complexes as an immunologic effect of oxaliplatin, and hypercoagulable state may be the reason for arterial thrombosis, digital microemboli, possible digital ischemia, and their several consequences.

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Ai, Tomohiko, Chihiro Hashimoto, and Takashi Iguchi. "Bilateral Segmental Digital Ischemia During Sepsis." Medical Science Case Reports 3 (July 29, 2016): 64–66. http://dx.doi.org/10.12659/mscr.899585.

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Torre, Joanne. "Ulnar artery aneurysm with digital ischemia." Vascular Medicine 4, no. 3 (August 1999): 143–45. http://dx.doi.org/10.1177/1358836x9900400304.

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Pin, Paul G., Gregorio A. Sicard, and Paul M. Weeks. "Digital Ischemia of the Upper Extremity." Plastic and Reconstructive Surgery 82, no. 4 (October 1988): 653–57. http://dx.doi.org/10.1097/00006534-198810000-00016.

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Pacchioni, Andrea, Jorge Sanz Sanchez, and Gabriele Luigi Gasparini. "Digital Ischemia After Snuffbox Radial Approach." JACC: Cardiovascular Interventions 13, no. 24 (December 2020): 2940–42. http://dx.doi.org/10.1016/j.jcin.2020.09.017.

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Janák, David, David Ručka, Jaroslav Kudlička, Vilém Rohn, Jaroslav Lindner, and Otomar Kittnar. "Acute Digital Ischemia Associated with Closed Injury." Prague Medical Report 116, no. 3 (2015): 239–43. http://dx.doi.org/10.14712/23362936.2015.64.

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Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel’s inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

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Lau, Richard A., Ramandeep Bains, Duminda Suraweera, Jane Ma, Emil R. Heinze, Andrew L. Wong, and Philip J. Clements. "A Rare Case of Digital Ischemia and Gangrene in ANCA-Associated Vasculitis with Review of the Literature." Case Reports in Rheumatology 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/2421760.

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This paper describes one patient with Antineutrophil Cytoplasmic Antibody- (ANCA-) associated vasculitis who initially presented with multiple ischemic fingers and toes. On further evaluation, the patient was also found to have pulmonary-renal involvement and episcleritis. The diagnosis was supported with a positive cANCA (anti-proteinase 3) and a bronchoscopy consistent with diffuse alveolar hemorrhage. Although the patient refused a tissue biopsy, clinical presentation including nasal ulceration, sinus congestion, and epistaxis and anti-proteinase 3 antibody were more consistent with Granulomatosis with Polyangiitis (GPA) rather than Microscopic Polyangiitis (MPA) or Eosinophilic Granulomatosis with Polyangiitis (EGPA) based on the recently presented ACR/EULAR Provisional 2017 Classification Criteria for GPA (Luqmani et al., 2016). The patient responded well to therapy including high dose steroids and cyclophosphamide, with improvement of all organs involved and had no further digital ischemia or gangrene on follow-up. We include a review of the English literature summarizing presentation, management, and outcome of 16 similar cases.

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Yudkina, N., A. Volkov, E. Nikolaeva, and E. Nasonov. "AB0629 VASCULAR MANIFESTATIONS OF SYSTEMIC SCLEROSIS: SIMILAR IN PATHOGENESIS, DIFFERENT IN FREQUENCY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1610.2–1610. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6656.

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Background:Pulmonary arterial hypertension (PAH) is one of the main manifestations of vascular involvement in systemic sclerosis (SSc). The association of PAH with Raynaud’s phenomenon (RP) and digital ischemic disorders is assumed.Objectives:The aim of the study to detect of the possible relationship of pathogenetically similar processes and the predictor role in the early diagnosis of PAH and digital ischemic disorders by the nailfold videocapillaroscopy (NVC).Methods:111 patients with SSc (51 patients with PAH (SSc-PAH) and 60 patients without PAH) include in this study. In all patients, the diagnosis of SSc was validated according to the 2013 ACR-EULAR criteria. PAH was diagnosed by right heart catheterization. NVC was performed in all recruited subjects. Capillary quantitative parameters (loops length and width, capillary density, neoangiogenesis) were evaluated and a semi-quantitative scoring was used (specific patterns - early, active and late) to define microvascular alterations. The test evaluated the presence of capillaroscopic changes in the nailfold bed on 2-5 fingers of both hands. The normal capillaroscopic pattern was characterized by the presence of 7-11 capillaries in the form of hairpins per 1 mm. Pathological patterns were characterized by morphological and structural changes, such as expanded and giant capillaries, hemorrhages, avascular fields, neoangiogenesis. The capillaroscopy pattern (normal, non-specific, early/active/late) was determined qualitatively. Decreased capillary density, dilated, giant or branched capillaries, microhemorrhages were evaluated semi-quantitatively.Results:RP was detected in 100% of cases in both groups. In the analysis of capillaroscopic patterns in both groups, the early and late scleroderma types of changes prevailed, but no significant differences were noted. Typical scleroderma patterns were found in 51 patients (100%) with SSc-PAH. In 3 patient with SSc without PAH, the abnormalities were regarded as non-specific. The NVC pattern was detected to be early in 8 patients with SSc-PAH and in 11 with SSc without PAH. The NVC pattern was found to be active in 16 patients with SSc-PAH and in 18 with SSc without PAH. The NVC pattern was detected to be late in 27 patients with SSc-PAH and in 28 with SSc without PAH. In addition to RP, the development of digital ulcers was noted with equal frequency in history (25 patients with SSc-PAH and 32 with SSc without PAH). Also, the time to their appearance from the first symptom of SSc was the same (56 (16; 84) months and 44 (23; 72) months, respectively). Severe forms of digital ischemic disorders were observed rarely and with the same frequency in the studied groups. Ischemia in 2 patients with SSc-PAH and in 5 patients with SSc without PAH, gangrene in 2 patients only in the SSc group without PAH, amputation in 1 of each group.Conclusion:In the course of the study, it was not possible to identify differences between the NVC patterns, the frequency and severity of digital ischemic disorders in the compared groups. That fact does not allow using the NVC as an early diagnosis of PAH in SSc. However, the NVC can help predict the development of digital ischemic disorders.References:NoDisclosure of Interests:None declared

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Schiopu, Elena, Ann J. Impens, and Kristine Phillips. "Digital Ischemia in Scleroderma Spectrum of Diseases." International Journal of Rheumatology 2010 (2010): 1–8. http://dx.doi.org/10.1155/2010/923743.

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Systemic Sclerosis (Scleroderma, SSc) is a disease of unknown etiology characterized by widespread vasculopathy and extracellular matrix deposition leading to fibrosis and autoimmune processes. Digital ischemia (digital ulcers (DUs)) is the hallmark of SSc-related vasculopathy and is characterized by endothelial dysfunction leading to intimal proliferation and thrombosis. It happens frequently (30% of the patients each year) and it is associated with significant morbidity. This paper summarizes the current information regarding pathogenesis, definitions, management, and exploratory therapies in DUs associated with SSc.

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Charney, Mark A., and Peter J. Stern. "Digital ischemia in clandestine intravenous drug users." Journal of Hand Surgery 16, no. 2 (March 1991): 308–10. http://dx.doi.org/10.1016/s0363-5023(10)80116-9.

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TAYLOR, LLOYD M., M. D., JAMES M. EDWARDS, and JOHN M. PORTER. "Digital Ischemia as a Manifestation of Malignancy." Annals of Surgery 206, no. 1 (July 1987): 62–68. http://dx.doi.org/10.1097/00000658-198707000-00010.

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Khairalla, Eric. "EPINEPHRINE-INDUCED DIGITAL ISCHEMIA RELIEVED BY PHENTOLAMINE." Plastic and Reconstructive Surgery 108, no. 6 (November 2001): 1831–32. http://dx.doi.org/10.1097/00006534-200111000-00085.

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Paw, P., S. M. Dharan, and J. M. Sackier. "Case reports Digital ischemia and occult malignancy." International Journal of Colorectal Disease 11, no. 4 (August 16, 1996): 196–97. http://dx.doi.org/10.1007/s003840050043.

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Todoli Parra, José A., Manuel Miralles Hernández, and Manuel A. Arrébola López. "Efficacy of Bosentan in Digital Ischemic Ulcers." Annals of Vascular Surgery 24, no. 5 (July 2010): 690.e1–690.e4. http://dx.doi.org/10.1016/j.avsg.2010.03.011.

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Busconi, Brian D., and William J. Morgan. "ACUTE DIGITAL ISCHEMIA IN A BODY BUILDER." Orthopedics 21, no. 1 (January 1998): 85–87. http://dx.doi.org/10.3928/0147-7447-19980101-18.

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