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Abstract:

Aim: was to estimate results of endovascular treatment of subclavian arteries lesions.

Materials and methods: study analyzes results of endovascular treatment of patients with occlusive-stenotic lesions of subclavian arteries. For the period 2014-2018, 87 endovascular interventions were performed on subclavian arteries. Indication for surgery was occlusion of subclavian artery or stenosis of more than 70% with the development of steal-syndrome. Before surgery, all patients underwent duplex scanning of brachiocephalic vessels and CT angiography of branches of the aortic arch with cerebral phase. There was no difference in severity of symptoms and comorbidity between patients with stenosis or occlusions (р>0,05). In case of stenosis, direct stenting of subclavian artery was performed. For occlusions, mechanical recanalization was performed using hydrophilic wires, balloon angioplasty followed by stenting. In all cases, we used a balloon-expandable stent.

Results: technical success was achieved in 98,8% of interventions. There were no lethal outcomes, myocardial infarction, or stroke. In one patient, brachial artery thrombosis occurred in early postoperative period; thrombectomy from the brachial artery was performed with restoration of blood flow. Patency of subclavian artery after 1 and 3 years was 100% and 94%, respectively.

Conclusions: endovascular interventions for occlusive-stenotic lesions of subclavian arteries is an effective and safe method of treatment of vertebrobasilar insufficiency.

 

 

 

References

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9.     Eisenhauer AC. Subclavian and innominate revascularization: surgical therapy versus catheter-based intervention. Curr. Interv. Cardiol. 2000; 2: 101-110.

10.   Mousa AY, Abu Rahma AF, Bozzay J, et al. Anatomic and clinical predictors of reintervention after subclavian artery stenting. J. Vasc. Surg. 2015; 15.

11.   Tomoi Y, Soga Y, Fujihara M, et al. Outcomes of endovascular therapy for upper extremity peripheral artery disease with critical hand ischemia. J Endovasc Ther. 2016; 23: 717-22

12.   Endovascular surgery. National guideline: In 4 books. Vol.3. (ed.by acad. BG Alekyan). М: Litterra, 2017 [In Russ].

13.   National guidelines by treatment of patients whith brachiocephalic arteries deseases. Angiology and vascular surgery (Suppl.). 2013; 19(2) [In Russ].

14.   Usai MV, Bosiers M, Bisdas T, et al. Surgical versus endovascular revascularization of subclavian artery arteriosclerotic disease. The Journal of Cardiovascular Surgery. 2018.

15.   Aboyans V, Ricco J-B, Bartelink M-L, et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55: 305-368.

16.   Benhammamia M, Mazzaccaro D, Ben Mrad M, et al. Endovascular And Surgical Management Of Subclavian Artery Occlusive Disease: Early And Long Term Outcomes. Annals of Vascular Surgery. 2020.

17.   Alekyan BG, Zakaryan NV, Shumilina MV, et al. Low term and long term outcomes of stenting by subclavian artery deseases. Thoracic and cardiovascular surgery. 2011; 1: 24-31 [In Russ].

18.   De Vries JP, Jager LC, van den Berg JC. Durability of Percutaneous trans- luminal angioplasty for obstructive lesions of proximal subclavian artery: long term results. J. Vasc. Surg. 2005; 41: 19-23.

19.   Linni K, Ugurluoglu A, Mader N, et al. Endovascular management versus surgery for proximal subclavian artery lesions. Ann. Vasc. Surg. 2008; 22(6): 769-67.

 

Abstract

This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.

  

References 

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9.     Gavrilenko A.V., Kotov A.E., Murav'eva YA.YU. The effect of tactical errors on results of surgical treatment in patients with critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2010; 16(1):138-143. [In Russ.]

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19.   Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: An intention-to-treat analisys of amputation-free and overall survival in patients randomized to a bypass surgery-first or a ballon angioplasty-first revascularization strategy. J. Vasc. Surg. 2010; 51: 5-17.

20.   Lindgren H, Qvarfordt P, Ekesson M, et al Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg. 2017        May; 53(5):686-694.

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24.   Deloose K, Callaert J. Less is more: the "As Less As Reasonably Achievable Stenting" (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):495-503.

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31.   Werk M, Albrecht T, Dirk-Roelfs Meyer D-R, et al. Paklitaxel-Coated Balloons Reduse Restenosis After Femoropopliteal Angioplasty. Circ. Cardivasc. Interv. 2012; 5:831-840.

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33.   Diamantopoulos A, Gupta Y, Zayed H. et al Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; epub ahead of print.

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38.   Bays S. The use of scoring balloons in the superficial femoral artery. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):504-511.

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Abstract:

Aim: was to show results of visceral revascularization in patients with chronic abdomina ischemia.

Materials and methods: 24 patients with chronic abdominal ischemia underwent endovascular revascularization.

Results: technical success was 100%. After endovascular revascularization, 19 (90%) of symptomatic patients noted improvement in the state of health in the form of a significant decrease of dyspepsia and abdominal pain. In the long-term period, 15 patients were examined (within 1 year). All examined patients underwent ultrasound of the abdominal cavity and CTA of the aorta. All patients had no symptoms of abdominal ischemia and signs of restenosis.

Conclusions: endovascular methods should be considered as the first line in the treatment of atherosclerotic lesions of superior mesenteric artery (SMA) and celiac trunk, which are accompanied by fewer periprocedural complications and mortality, better rates of rehabilitation and shorter hospital stay. 

 

References

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3.      Gavrilenko A.V., Kosenkov A.N. Diagnosis and surgical treatment of chronic arterial ischemia. M.: Graal, 2000; 308 [in Russ].

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7.      Pokrovskij A.V. Diseases of aorta and its branches. M.: Meditsina, 1979; 324 [in Russ].

8.      Kougias P, El Sayed HF, Zhou W, Lin PH. Management of chronic mesenteric ischemia. The role of endovascular therapy. J. Endovasc. Ther. 2007; 14 (3): 395-405.

9.      Beaulieu R.J., Arnaoutakis K.D., Abularrage C.J., Efron D.T., Schneider E., Black J.H. Comparison of open and endovascular treatment of acute mesenteric ischemia. J. Vasc. Surg. 2014; 59 (1): 159-64.

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11.    Moghadamyeghaneh Z., Carmichael J.C., Mills S.D., Dolich M.O., Pigazzi A., Fujitani R.M., et al. Early outcome of treatment of chronic mesenteric ischemia. Am. Surg. 2015;81:1149-56

12.    Grilli C.J., Fedele C.R., Tahir O.M., et al. Recanalization of chronic total occlusions of the superior mesenteric artery in patients with chronic mesenteric ischemia: technical and clinical outcomes. J. Vasc. Interv. Radiol. 2014; 25(10):1515-1524

13.    Sharafuddin M., Nicholson R., Kresowik T., Amin P.B., Hoballah J.J., Sharp W.J. Endovascular recanalization of total occlusions of the mesenteric and celiac arteries. J. Vasc. Surg. 2012; 55(6):1674-1681.

 

 

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

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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.

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