Successful Revascularization Using Intravascular Ultrasound-Guided Wiring in Severe Digital Ischemia With Occluded Radial and Ulnar Arteries: A Case Report.

With recent advances in endovascular therapy (EVT), treatment of complex peripheral artery disease, especially below-the-knee lesions, has become increasingly feasible using intravascular ultrasound (IVUS)-guided techniques. However, reports on EVT for critical digital ischemia remain scarce because of its rarity. We report a case of successful distal digital revascularization using IVUS-guided wiring. The patient was a 62-year-old man with untreated diabetes who presented with progressive non-healing ulcers on the right second to fourth fingers. Angiography revealed chronic total occlusions of the right radial and ulnar arteries. IVUS-guided parallel wiring enabled guidewire passage from the ulnar artery to the common palmar digital arteries of the second and fourth digits. Balloon angioplasty resulted in adequate distal flow and clinical improvement. This case demonstrates the potential of IVUS-guided EVT in managing complex upper extremity ischemia.