Abstract:

Aim: was to combine results of surgical treatment of patients with primary reconstruction of arteries of lower limbs with patients who underwent reconstructive operations on early stented arteries.

Materials and methods: research included 93 patients with critical ischemia of lower limbs. All patients were devided into two groups with division to subgroups. Group 1a - 23 patients after stenting of iliac arteries. Group 1b - 23 patients with stenosis or occlusion of iliac arteries without previous operations. Group 2a - 22 patients with thrombosis or restenosis of arteries lower than inguinal ligament after previous endovascular treatment. Group 2b - 25 patients with primary atherosclerotic lesion of arteries of lower limbs lower than inguinal ligament .

Results: in early postoperative period and 6 months after reconstructive operation there were no difference in all groups and subgroups of treated patients. The level of complications in late post-operative period is lower in case of primary reconstruction of arteries lower than inguinal ligament in comparison with operations after endovascular interventions.  

References

1.     Bokeria L.A., Temrezov M.B., Kovalenko M.I. et al. Urgent problems of surgical treatment of patients with KINK solutions of (state the problem). Annals ofsurgery. 2011; 1: 5-9 [In Russ].

2.     Pokrovsky A.V., Gontarenko V.N. The condition of vascular surgery in Russia in 2013. 2014; Angiology and vascular surgery. 3-55 [In Russ].

3.     Gavrilenko A.V., Skrylev A.V. Surgical treatment of patients with critical limb ischemia (CLI caused by damage to the arteries infrainguinal localization. Angiology and vascular surgery. 2008; 14: 111-117 [In Russ].

4.     Diehm N., Baumgartner I., Jaff M., Do D.D, Minar E., Schmidli J., Diehm C., Biamino G., Vermassen F., Scheinert D., Van Sambeek M.R., Schillinger M. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischaemia of lower limb arteries. Eur. Heart J. 2007; 28:798-805.

5.     Gruberg L., Hong M.K., Mintz G.S., Mehran R., Waksman R., Dangas G., Kent K.M., Pichard A.D., Satler L.F., Lansky A.J., Kornowski R., Stone G.W., Leon M.B. Optimally deployed stents in the treatment of restenotic versus de novo lesions. Am. J. Cardiol. 2000 Feb 1; 85(3):333.

6.     Bondarenko O.N., Galstjan G.R., Ajubova N.L., Egorova D.N., Dedov 1.1. Rol' ul'trazvukovogo dupleksnogo skanirovanija v ocenke ishodov jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej v rannie sroki nabljudenija [The role of ultrasonic duplex scanning in estimation of results of endovascular interventions in patients with diabetus mellitus and critical ischemia of lower limbs in early postoperative period]. Diagnosticheskaja i intervencionnaja radiologija. 2014; 8(3)15-28 [In Russ]. 

Abstract:

This study was aimed to show effectiveness of endovascular procedures in patients with critical lower limb ischemia (CLI), caused by lesions of iliac and femoral-popliteal-tibial segment's of arteries.

Materials and methods: study includes results of treatment of 68 patients, who underwent endovascular procedures.

Results: primary technical success in group with A, B, C TASC II aortoiliac lesions was 100%, with D TASC II aortoiliac lesions was 91,7%. In group with infrainguinal lesions overall primary technical success was 91,9%. Regression of ischemia was marked in all patients. The average growth of the ankle-brachial index (ABI) was 0,3. During one year of follow-up period, 3 major amputations were performed (5,8% of follow-up patients) in group of interventions of shin arteries with one recanalized tibial artery Salvation of lower limbs was 94,2% without CLI signs reccurence.

Conclusion: endovascular interventions are effective, minimally invasive treatment for CLI. Endovascular procedures such as angioplasty with or without stenting showld be seen as a treatment of choise in patients with CLI for limb salvage.

References

1.   Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami arterij nizhnih konechnostej [National recommendation for treatment of patients with diseases of lower limbs’ arteries]. M. 2013; 74[ In Russ].

2.     Fowkes F.G., Housley E., Cawood E.H. Edinburgh artery study: prevalence о! asymptomatic and symptomatic peripheral arterial disease in the general population. Int. J. Epidimiol. 1991; 20: 38-92.

3.     ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2006; 113: 11: 463-654.

4.     Bokerija L.A., Gudkova R.G. Serdechno-sosudistaja hirurgija-2014. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija [Cardiovascular surgery - 2014. Congenital anomalies and diseases of blood circulation]. M.: NCSSH im. A.N. Bakuleva. 2015[In Russ].

5.    Gavrilenko A.V., Skrylev S.I., Kuzubova E.A. Ocenka kachestva zhizni u pacientov s KINK[Quality of life in patients with CLI]. Angiologija i sosudistaja hirurgija. 2001; 3: 8-13[In Russ].

6.    Papojan S.A., Abramov I.S., Majtesjan D.A. i dr. Gibridnye operacii pri mnogojetazhnyh porazhenijah arterij nizhnih konechnostej [Hybrid operations in multifocal lesions of lower limbs’ arteries]. Angiologija i sosudistaja hirurgija. 2012; 18 (2): 138-141[In Russ].

7.    Pokrovskij A.V. Klinicheskaja angiologija[Clinical angiology]. M: Medicina 2004; 808[ In Russ].

8.     Nasr M.K., McCarthy R.J., Budd J.S., Horrocks M. Infrainguinal bypass graft patency and limb salvage rates in critical limb ischemia: influence of the mode of presentation. Ann Vasc Surg 2003; 17: 192-197.

9.     Faries P.L., Logerfo F.W., Arora S., Hook S., Pulling M.C., Akbari C.M., et al. A comparative study of alternative conduits for lower extremity revascularization: all-autogenous conduit versus prosthetic grafts. J. Vasc. Surg. 2000;32:1080-1090.

10.   Gavrilenko A.V., Kotov A.Je., Shatalova D.V. Rezul'taty otkrytyh rekonstruktivnyh vmeshatel'stv na ranee stentirovannom uchastke arterij u pacientov s kriticheskoj ishemiej nizhnih konechnostej [Results of open reconstructive operations on previously stented arteries of lower limbs in patients with critical ischemia]. Diagnosticheskaja i intervencionnaja radiologija. 2015; 9 (1): 34-38 [In Russ].

11.   Conte M.S., Geraghty P.J., Bradbury A.W. et al. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J. Vasc. Surg. 2009; 50: 1462-1473.

12.   Kudo T., Chandra F.A., Kwun W.H. et al: Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. Open bypass surgery. J. Vasc. Surg. 2006; 44: 304-313.

13.   Molloy K.J., Nasim A., London N.J. et al. Percutaneous transluminal angioplasty in the treatment of critical limb ischemia. J. Endovasc. Ther. 2003; 10 (2): 298-303.

14.   Nasr M.K., McCarthy R.J., Hardman J. et al. The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2002; 23 (5): 398-403.

15.   Faglia E., Dalla P.L., Clerici G., et al. Peripheral angioplasty as the first choice revascularizaion procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur. J. Vasc. Endovasc. Surg. 2005; 29 (6): 620-627.

16.   Giles K.A., Pomposelli F.B., Spence T.L., Hamdan A.D., Blattman S.B., Panossian H., Schermerhorn M.L. Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs. J. Vasc. Surg. 2008; 48:128-136.

17.   Conrad M.F., Cambria R.P., Stone D.H. et al. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J. Vasc. Surg. 2006; 44:762-769.

18.   Adam D.J., Beard J.D., Cleveland T. et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366: 1925-1934.

19.  Zatevahin I.I., Shipovskij V.N., Zolkin V.N. Balonnaja angioplastika pri ishemii nizhnih konechnostej [Ballon angioplasty in patients with CLI] M.: Medicina. 2004; 256 [In Russ].

20.   Kudo T., Chandra F.A., Ahn S.S. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J. Vasc. Surg. 2005; 41:423-35; discussion 435.

21.   Beard J.D. Which is the best revascularization for critical limb ischemia: endovascular or open surgery? J. Vasc. Surg. 2008; 48(6 Suppl):11S-6S.

22.   Xiaoyang Fu., Zhidong Zhang., Kai Liang et al. Angioplasty versus bypass surgery in patients with critical limb ischemia - a meta-analysis Int. J. Clin. Exp. Med. 2015; 8(7): 10595-10602.

23.   Philip B.Dattilo, Ivan P.Casserly. Critical Limb Ischemia: Endovascular Strategies for Limb Salvage. Progress in Cardiovascular Diseases. 2011; 54: 47-60.

24.   Faglia E., Clerici G., Caminiti M. et al. Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization Data of a cohort study of 564 consecutive diabetic patients. J. Diabetes Complications. 2010; 24(4): 265-269.

25.   Hinchliffe R.J., Andros G., Apelqvist J. et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012; 28 Suppl 1:179-217.

26.   Holman N., Young R.J., Jeffcoate W.J. Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia. 2012; 55(7): 1919-1925.