Abstract:

Aim: was to evaluate the effectiveness of endovascular interventions in patients with critical limb ischemia (CLI) with multilevel extended lesions of lower limb arteries of types C and D according to TASC II.

Materials and methods: a retrospective analysis of results of surgical treatment of patients with critical limb ischemia, who underwent 127 endovascular interventions on arteries of the femoral- popliteal-tibial segment for the period from 2007 to 2020, was carried out. 15 patients had ischemic limb pain at rest (11,8%) and 112 patients had trophic lesions (88,2%). Our study included patients with arterial lesions of type C (18 patients, 14,2%) and type D (109 patients, 85,8%) according to TASC II.

Results: technical success of performed endovascular interventions was 95,3%. Within a 30-day period, 2 patients (1,6%) had myocardial infarction, 3 patients (2,4%) underwent early «high» amputation. Perioperative mortality was 0,8% (1 patient). Primary patency of endovascular interventions was 87%, 58% and 36% after 1, 3 and 5 years, respectively, while secondary patency was 91%, 81% and 58% after 1, 3 and 5 years, respectively. Limb salvage rate was 93%, 89% and 79% after 1, 3 and 5 years, respectively. Patient survival rate was 95%, 84% and 78% after 1, 3 and 5 years, respectively.

Conclusions: endovascular interventions on femoral-popliteal-tibial arterial lesions of types C and D according to TASC II in patients with critical limb ischemia are effective, and modern method of treatment with good immediate and long-term results.

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Abstract:

Inferior vena cava (IVC) abnormalities are reported to occur in 3% of the population, and bilateral IVC is the most common one. We presented a case of a patient with bilateral IVC and pulmonary embolism threat due to deep vein thrombosis of the left leg and thrombus flotation in the left external iliac vein. Two cava-filters were placed. The need of two devices is obvious, because emboli can easily reach the pulmonary artery via either right or left IVC.

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Abstract:

This article presents a review of the literature on treatment of multifocal atherosclerosis of iliac arteries and arteries of lower extremities. Adequate correction of arterial inflow provides normal functioning of distal reconstructions. Combination of endovascular correction of arterial inflow with open surgical reconstructions of arterial outflow maximizes limb revascularization and this leads to less surgical trauma and less complications. Hybrid operations allow to achieve maximum results in terms of hemodynamics in patients with multi-segmental lesions. Immediate and long-term results of such operations are not worse than similarly isolated interventions in each segments. Hybrid operations show their worth and effectiveness in all lesions of aorto-iliac segment, including TASC C and D. Reduced operational trauma during hybrid operations, compared with one-stage surgical reconstruction, and the possibility to perform interventions under regional anesthesia, are particularly important in patients at high risk of comorbidity

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Abstract:

Purpose: Was to observe the immediate and long-term results of hybrid operations in multilevel atherosclerotic lesions of aorto-iliac(AIS) and femoral-popliteal segments (FPS). Article describes the method of the hybrid intervention in the aorto-iliac segment

Materials and Methods: For the period of 2007-2011 - 40 patients with multilevel lesions of iliac arteries and lower limb arteries underwent hybrid operations. 57.5% of patients had aorto-iliac segment disease, classified as TASC C, and 42,5% - TASC D. Lesions of femoral-popliteal segment was divided in the following order: TASC A - 15,0%, TASC B - 35,0%, TASC C - 42,5% and TASC D - 7,5%. We applied loop endarterectomy with stenting for the correction of the aorto-iliac lesions. For arterial outflow correction we applied surgical operations. Follow-up period has been traced for 3 years.

Results: Primary technical success was achieved in 97.5%. Complications of the immediate postoperative period were noted in 15%. Long-term results were traced for 3 years in 70% of patients. Three-year assisted patency of aorto-iliac segment was 89%. All complications have been corrected only by endovascular procedure. Three-year cumulative patency of femoral-popliteal segment was 87%.

Conclusions: This technique allows achieving the best results in reducing lower limb ischemia. Simultaneous correction of both - inflow and outflow segments improved long-term results of each of the reconstruction. The method shows its effectiveness in patients with TASC C and TASC D lesions of aorto-iliac segment. Reduction of surgical trauma significantly affects the results in group of high risk patients. 

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