Clinical application for DSA combined with a double-chamber Fogarty catheter in the treatment of venous crisis

Abstract

Introduction: Venous crisis, as a common vascular crisis post limb replantation, is usually treated with surgical exploration. Aim: To investigate effects of digital subtraction angiography (DSA) combined with double-chamber Fogarty balloon catheter on venous crisis post replantation of limbs. Material and methods: Twelve patients suffering from severed limbs were involved in this study. Patients underwent DSA combining double-chamber Fogarty balloon catheter operation. Colour Doppler ultrasound was used to diagnose patients with venous crisis. Patients were treated with rehydration, anti-infection, anticoagulation, and vasodilation. Indexes, including total joint active activity, working condition, remaining symptoms, appearance, feeling, and muscle strength, were evaluated. Results: During operation, the limb was shortened to 0-1 cm in 8 cases, to 1-2 cm in 2 cases, and to 2-2.5 cm in 2 cases. According to DSA findings, popliteal vein thrombosis was formed at 0.6-4.2 cm and was removed from the popliteal vein. After removal of the thrombosis, DSA images showed re-canalization of the popliteal vein. A typical case of a 16-year-old patient underwent limb replantation; however, venous crisis was formed post operation. Postoperative colour Doppler ultrasound findings indicated re-canalization of the popliteal vein. Tibia and fibula were reduced and internally fixed, while the limb was survived post-operation. The degree of swelling of limbs was improved, and skin temperature was normal or 0.6-1.5°C lower than affected limbs. Skin colour was normal and activity was improved. Patients demonstrated sensory recovery grade of S3+and two-point discrimination of 4.5 mm. Conclusions: DSA combining double-chamber Fogarty balloon catheter, as a minimally invasive and fast approach, could accurately locate thrombi and improve pertinence of vein branches.