Abstract: Introduction: all over the world, the number of patients with peripheral arterial lesions is growing, the progression of the disease leads to the chronic limb-threatening ischemia (CLTI) with an increasement in mortality. To carry out revascularization, it is required to accurately determine the degree and length of lesions of arteries of limbs, with the creation of a «road map» of lesions and the choice of the least affected artery ? the target arterial pathway. Aim: was to determine the effectiveness of CT angiography in diagnosing lesions of shin arteries in patients with critical lower limb ischemia (CLI) by calculating its sensitivity and specificity in comparison with digital subtraction angiography. Materials and methods: the study included 26 patients (15 men and 11 women, average age of patients 69,3 ± 10,8 years) with critical lower limb ischemia, against the background of lesions of the femoro-popliteal segment of arteries, class D TASC II. All patients underwent CT angiography on a 64-spiral computed tomography scanner. Obtained data was compared with results of catheter angiography (digital subtraction angiography), used as a reference method. Results: the sensitivity of CT angiography in determining the degree of lesion (stenosis or occlusion) of leg arteries was 100% and 94%, the specificity was 83% and 96%, respectively. The overall accuracy of CT angiography in the tibial segment was 87% for stenoses and 94% for occlusions. According to results of CTA, massive calcification was detected in 13% of cases from the total number of analyzed arteries. When evaluating these arteries according to DSA data, most of arteries (11 of 12) were occluded, and the length of occlusions in 8 cases was maximum according to the GLASS classification (the length was more than 1/3 of the artery length). The presence of strong correlations between CT angiography and digital angiography on the presence of occlusions, stenoses> 50% and their length was determined. Conclusions: CT angiography is a highly informative method for diagnosing the degree and length of lesions of shin arteries in patients with critical lower limb ischemia. References 1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7 2. Reinecke H, Unrath, M, Freisinger E, et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. European heart journal. 2015; 36(15), 932-938. https://doi.org/10.1093/eurheartj/ehv006 3. National guidelines for the diagnosis and treatment of lower limb arterial diseases. Expert group for the preparation of recommendations: chairmen of the expert group Academician of the Russian Academy of Sciences Bokeria LA, Academician of the Russian Academy of Sciences Pokrovsky AV. Moscow, 2019 [In Russ]. http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf 4. Aboyans V, Ricco JB, Bartelink M, et al. ESC Scientific Document Group (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European heart journal. 2018; 39(9): 763-816. https://doi.org/10.1093/eurheartj/ehx095 5. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33 (1): 1-75. https://doi.org/doi:10.1016/j.ejvs.2006.09.024 6. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019; 69(6S): 3-125. https://doi.org/doi:10.1016/j.jvs.2019.02.016 7. Pokrovsky AV, Yakhontov DI. The value of assessing the outflow tract in femoral-tibial reconstructions. Rossijskij Mediko-biologicheskij vestnik im. akademika I.P. Pavlova. 2013; 4: 104-112 [In Russ]. 8. Hamburg NM, Creager MA. Pathophysiology of Intermittent Claudication in Peripheral Artery Disease. Circulation journal: official journal of the Japanese Circulation Society. 2017; 81(3): 281-289. https://doi.org/10.1253/circj.CJ-16-1286 9. Bollinger A, Breddin K, Hess H, et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis. 1981; 38(3-4): 339-346. https://doi.org/doi:10.1016/0021-9150(81)90050-2 10. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3): 517-538. https://doi.org/doi:10.1016/s0741-5214(97)70045-4 11. Graziani L, Silvestro A, Bertone V, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg. 2007; 33(4): 453-460. https://doi.org/doi:10.1016/j.ejvs.2006.11.022 12. Radiation diagnostics of diseases of the heart and blood vessels. National leadership. (Ed. by LS Kokov; SK Ternovoj.) Moscow, GEOTAR-Media, 2011; 688 [In Russ]. 13. ?urovi? Sarajli? V, Toti? D, Bi?o Osmanagi? A, et al. Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia? Psychiatr Danub. 2019; 31(5): 814-820. 14. Al-Rudaini HEA, Han P, Liang H. Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia. Curr Med Imaging Rev. 2019; 15(5): 496-503. https://doi.org/doi:10.2174/1573405614666181026112532 15. Lim JC, Ranatunga D, Owen A, et al. Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting. J Comput Assist Tomogr. 2017; 41(2): 327-333. https://doi.org/doi:10.1097/RCT.0000000000000494 16. Mohler ER, Jaff MR Peripheral Artery Disease 2nd Edition. Wiley-Blackwell. 2017; 208. 17. Ayubova NL, Bondarenko ON, Galstyan GR, et al. Peculiarities of lesions of the arteries of the lower extremities and clinical outcomes of endovascular interventions in patients with diabetes mellitus with critical ischemia of the lower extremities and chronic kidney disease. Saharnyj diabet. 2013; (4): 85-94 [In Russ]. 18. Molitvoslovova NA, Manchenko OV, Jaroslavceva MV, et al. The relationship of calcification of the arteries of the lower extremities with the severity of distal neuropathy in patients with diabetes mellitus. Problemy jendokrinologii. 2013; 59(2): 7-11 [In Russ]. https://doi.org/10.14341/probl20135927-11 19. Konijn LCD, Takx RAP, de Jong PA, et al. Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients. Eur J Radiol. 2020; 132: 109305.
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. References 1. Conte MC, Bradbury AW, Kolh Ph, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of Vascular Surgery. 2019; 69(6): 123-125. https://doi.org/10.1016/j.jvs.2019.02.016 2. Pokrovskij AV, Ivandeev AS. Sostojanie sosudistoj hirurgii v Rossii v 2016 godu. M.: Obshhestvo angiologov i sosudistyh hirurgov. Moskva. 2017; 76 [In Russ]. 3. Barriocanal АM, L?pez A, Monreal M, Montan? E. Quality assessment of peripheral artery disease clinical guidelines. J Vascular Surgery. 2016; 63(4): 1091-1097. https://doi.org/10.1016/j.jvs.2015.12.040 4. Farber A, Eberhardt RT. The Current State of Critical Limb Ischemia. A Systematic Review. JAMA Surg. 2016; 151(11): 1070-1077. https://doi.org/10.1001/jamasurg.2016.2018 5. Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003-2011. J Am Coll Cardiol. 2016; 67(16): 1901-1913. https://doi.org/10.1016/j.jacc.2016.02.040 6. Duff S, Mafilio MS, Bhounsul P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vascular Health and Risk Management. 2019; 15: 187-208. https://doi.org/10.2147/VHRM.S209241 7. Darling JD, McCallum JC, Soden PA, et al. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia. J Vasc Surg. 2017; 66(2): 466-475. https://doi.org/10.1016/j.jvs.2017.01.024 8. Antoniou GA, Georgiadis GS, Antoniou SA, et al. Bypass surgery for chronic lower limb ischemia (Review). Cochrane Database of Systematic Reviews. 2017; 3(4): CD002000. https://doi.org/10.1002/14651858.CD002000.pub3 9. Uccioli L, Meloni M, Izzo V, et al. Critical limb ischemia: current challenges and future prospects. Vascular Health and Risk Management. 2018; 14: 63-74. https://doi.org/10.2147/VHRM.S125065 10. Norgren L, Patel MR, Hiatt WR, et al. Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial. Eur J Vasc Endovasc Surg. 2018; 55: 109-117. https://doi.org/10.1016/j.ejvs.2017.11.006 11. Spillerov? К, et al. Angiosome Targeted PTA is More Important in Endovascular Revascularisation than in Surgical Revascularisation: Analysis of 545 Patients with Ischaemic Tissue Lesions. Eur J Vasc Endovasc Surg. 2017; 3: 1-9. https://doi.org/10.1016/j.ejvs.2017.01.008 12. Pokrovskij AV, Kazakov YuI, Lukin IB. Kriticheskaja ishemija nizhnih konechnostej. Ifraingvinal'noe porazhenie. M.: Tver': Tver. Gos. Un-e. 2018; 225 [In Russ]. 13. Aboyans V, Ricco JB, Bartelink ME, et al. Editor’s choiced 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. https://doi.org/10.1093/eurheartj/ehx095 14. Brouillet J, Deloose K, Goueffic Y, et al. Primary stenting for TASC C and D femoropopliteal lesions: one-year results from a multicentric trial on 203 patients. The Journal of Cardiovascular Surgery. 2018; 59(3): 392-404. https://doi.org/10.23736/S0021-9509.16.09282-X 15. Schreuder SM, Hendrix Y, Reekers JA, Bipat S. Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review. Cardiovasc Intervent Radiol. 2018; 41(1): 1-20. https://doi.org/10.1007/s00270-017-1796-9 16. Norgren L, Patel MR, Hiatt WR, et al. Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial. Eur J Vasc Endovasc Surg. 2018; 55: 109-117. https://doi.org/10.1016/j.ejvs.2017.11.006 17. Papojan SA, Shhegolev AA, Radchenko AN, et al. Otdalennye rezul'taty jendovaskuljarnogo lechenija porazhenij poverhnostnoj bedrennoj arterii tipov S i D po klassifikacii TASC II. Angiologija i sosudistaja hirurgija. 2018; 24(1): 73-78 [In Russ]. 18. Biagioni RB, Biagioni LC, Nasser F, et al. Infrapopliteal Angioplasty of One or More than One Artery for Critical Limb Ischaemia: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2018; 55: 518-527. https://doi.org/10.1016/j.ejvs.2017.12.022 19. Schneider PA, Laird JR, Tepe G, et al. Treatment effect of drug-coated balloons is durable to 3 years in the femoropopliteal arteries: long-term results of the IN.PACT SFA randomized trial. 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Abstract: This review is focused on the problem of the angiosome principle of revascularization in critical limb ischemia. The blood circulation of the foot is described in accordance with the angiosome concept. Different opinions on the application of the angiosome principle of revascularization in critical lower limb ischemia are presented. Features of the angiosome principle that limit its routine use in clinical practice are described. Also, methods of perfusion evaluation that can be applied at all stages of the treatment process, allow to assess the severity of macro- and microcirculation impairment and result of revascularization are described. References 1. Taylor G.I., Pan W.R.. Angiosomes of the leg: anatomic study and clinical implications. Plast. Reconstr. Surg. 1998; 102(3):599-616. 2. Hinchliffe R.J., Brownrigg J.R.W., Apelqvist J.et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes. Metab. Res. Rev. 2016; 32 (Suppl. 1): 37-44. 3. Galstyan G.R., Tokmakova A.Yu., Egorova D.N. et al. Klinicheskie rekomendatsii po diagnostike i lecheniyu sindroma diabeticheskoy stopy. [Clinical guidelines on diagnostics and treatment of the diabetic foot syndrome]. Rany i ranevye infektsii. 2015; 2(3):63-83 [In Russ]. 4. Pokrovskiy A.V., Abugov S.A., Alekyan B.G. et al. Natsionalnye rekomendatsii po vedeniyu patsientov s zabolevaniyami arteriy nizhnikh konechnostey. [National guidelines on treatment of patients with lower limbs arterial disease]. Angiologiya i sosudistaya khirurgiya. 2013; 19 (Pril. 2):38. [In Russ]. 5. Gerhard-Herman M.D., Gornik H.L., Barrett C. et al. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017; 135(12):e726-e779. 6. Eroshkin I.A. Rentgenokhirurgicheskaya korrektsiya porazheniy arteriy nizhnikh konechnostey u bolnikh sakharnym diabetom i ee rol v kompleksnom lechenii sindroma diabeticheskoy stopy. [Endovascular correction of lower limbs arterial lesions in diabetics and its role in complex treatment of the diabetic foot syndrome]. Mezhdunarodnyy endokrinologicheskiy zhurnal. 2011; 36(4):139-148. [In Russ]. 7. Platonov S.A., Kaputin M.Yu., Ovcharenko D.V. et al. Rol kollateralnogo krovosnabzheniya stopy v zazhivlenii troficheskikh defektov i sokhranenii konechnosti u bolnykh s kriticheskoy ishemiey nizhnikh konechnostey. [The role of foot collaterals in ulcer healing and limb salvage in patients with critical limb ischemia]. Med. akad. zhurn. 2011; 11(3): 105-111. [In Russ]. 8. Alexandrescu V.A., Vincent G., Azdad K. et al. A reliable approach to diabetic neuroischemic foot wounds: below-the-knee angiosome-oriented angioplasty. J. Endovasc. Ther. 2011; 18 (3): 376-387. 9. Ferrufino-Merida A.L., Rodrnguez-Trejo J.M., Escotto-Sanchez I., Rodriguez-Ramhrez N.. Angioplastia infrapoplitea: correlaciуn entre el vaso tratado y el angio- soma lesionado. Rev. Mex. Angiol. 2012; 40 (4): 123-134. 10. Iida O., Nanto S., Uematsu M.. Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia. Catheter. Cardiovasc. Interv. 2010; 75(6):830-836. 11. Iida O., Soga Y, Hirano K. et al. Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below-the-knee lesions. J. Vasc. Surg. 2012; 55 (2):363-370. 12. Kabra A., Suresh K.R., Vivekanand V. at al. Outcomes of angiosome and non-angiosome target revascularization in critical lower limb ischemia. J. Vasc. Surg. 2013; 57 (1): 44-49. 13. Kret M.R., Cheng D., Azarbal A.F. et al. Utility of direct angiosome revascularization and runoff scores in predicting outcomes in patients undergoing revascularization for critical limb ischemia. J. Vasc. Surg. 2014; 59(1): 121-128. 14. Lejay A., Georg Y, Tartaglia E. et al. Long-term outcomes of direct and indirect below-the-knee open revascularization based on the angiosome concept in diabetic patients with critical limb ischemia. Ann. Vasc. Surg. 2014; 28(4):983-989. 15. Neville R.F., Attinger C.E., Bulan E.J. et al. Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann. Vasc. Surg. 2009; 23(3): 367-373. 16. Spillerova K., Biancari F., Leppдniemi A. et al. Differential impact of bypass surgery and angioplasty on angiosome-targeted infrapopliteal revascularization. Eur. J. Vasc. Endovasc. Surg. 2015; 49(4):412-419. 17. Soderstrom M., Alback A., Biancari F. et al. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J. Vasc. Surg. 2013; 57(2):427-435. 18. Varela C., Achn F., J. de Haro et al. The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model. Vasc. Endovascular Surg. 2010; 44(8):654-660. 19. Biancari F., Juvonen Т.. Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. Eur. J. Vasc. Endovasc. Surg. 2014; 47(5):517-522. 20. Bosanquet D.C., Glasbey J.C., Williams I.M., Twine C.P.. Systematic review and meta-analysis of direct versus indirect angiosomal revascularization of infrapopliteal arteries. Eur. J. Vasc. Endovasc. Surg. 2014; 48(1):88-97. 21. Jongsma H., Bekken J.A., Akkersdijk G.P. et al. Angiosome directed revascularization in patients with critical limb ischemia. J. Vasc. Surg. 2017; 65 (4): 1208-1219. 22. Rashid H., Slim H., Zayed H. et al. The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome. J. Vasc. Surg. 2013; 57 (5): 1219-1226. 23. Azuma N., Uchid H., Kokubo T. et al. Factors influencing wound healing of critical ischaemic foot after bypass surgery: is the angiosome important in selecting bypass target artery? Eur. J. Vasc. Endovasc. Surg. 2012; 43(3):322-328. 24. Pave M., Benadiba L., Berger L. et al. Below-the-knee angioplasty for critical limb ischemia: results of a series of 157 procedures and impact of the angiosome concept. Ann. Vasc. Surg. 2016;36:199-207. 25. Soares R. de A., Brochado Neto F.C., Matielo M.F. et al. Concept of angiosome does not affect limb salvage in infrapopliteal angioplasty. Ann. Vasc. Surg. 2016; 32: 34-40. 26. Fossaceca R., Guzzardi G., Cerini P et al. Endovascular treatment of diabetic foot in a selected population of patients with below-the-knee disease: is the angiosome model effective? Cardiovasc. Intervent. Radiol. 2013; 36(3):637-644. 27. Zheng X.T., Zeng R.C., Huang J.Y et al. The use of the angiosome concept for treating infrapopliteal critical limb ischemia through interventional therapy and determining the clinical significance of collateral vessels. Ann. Vasc. Surg. 2016; 32:41-49. 28. Graziani L., Silvestro A., Bertone V. et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur. J. Vasc. Endovasc. Surg. 2007; 33(4):453-460. 29. Alexandrescu V.A., Sцderstrцm M., Venermo M. Angiosome theory: fact or fiction? Scand. J. Surg. 2012; 101(2):125-131. 30. Spillerova K., Biancari F, Settembre N. et al. The prognostic significance of different definitions for angio- some-targeted lower limb revascularization. Ann. Vasc. Surg. 2017; 40:183-189. 31. Spillerova K., Sarderstram M., Albeck A., Venermo M.. The feasibility of angiosome-targeted endovascular treatment in patients with critical limb ischemia and foot ulcer. Ann. Vasc. Surg. 2016; 30:270-276. 32. Alexandrescu V.A.. The angiosome concept: anatomical background and physiopathological landmarks in CLI. In: Angiosomes applications in critical limb ischemia: in search for relevance. Torino: Minerva Medica S.p.A. 2013; 1-9. 33. Bregovskiy V.B., Karpova I.A., Alekseeva E.S.. Narusheniya kozhnoy mikrocirkulyacii v nizhnikh konechnostyakh pri sakharnom diabete: patofiziologicheskiy fenomen ili obekt dlya lecheniya? [Microcirculation disturbance in lower limbs in diabetics: pathophysiological phenomenon or subject of treatment?]. Sakharnyy diabet. 2011;14 (3):49-53. [In Russ]. 34. Utsunomiya M., Takahara M., Iida O. et al. Wound blush obtainment is the most important angiographic endpoint for wound healing. JACC Cardiovasc. Interv. 2017; 10 (2):188-194. 35. Iezzi R., Santoro M., Dattesi R. et al. 36. Reekers JA, The Role of Interventional Radiology in the Treatment of Arterial Diabetic Foot Disease. Cardiovasc inter rad 2016;39(10):1369-1371.
Abstract: РТА and stenting of lower limb s arteries was performed in 28 diabetic patients with critical limb ischemia. Technical success rate of interventions was 96,3%. Clinical success rate after the procedure was 64,3%. Mean values of basal ТсРО2 on the foot after operation increased on 11 mm of mercury. At a favorable outcome of treatment ankle-brachial index values increased on 0,2-0,4. Ischemia recurrence rate was 25%. All recurrences of ischemia were observed in period of 3 to 9 months. Cumulative limb salvage rate in 6 months was 80 %, in 12 months - 75%. In short period of observation PTA and stenting in diabetic patients is able to eliminate the necessity of amputation in majority of patients. Considering weight of the general condition of such patients, presence of accompanying diseases, risk of development of complications of surgical treatment, РТА can be considered as operation of the first choice. Reference 1. Rutherford R.B., Durham J. Percutaneous balloon angioplasty for arteriosclerosis obliterans: Long-term results. In Pearce W.H. (eds). Technologies in Vascular Surgery. 1992; 32-345. 2. Шиповский В.Н. Баллонная ангиопластика в лечении хронической ишемии нижних конечностей.Дис. д-ра мед. наук. 2002; 16-17. 3. Jeans W.D., Armstrong S. Fate of patients undergoing transluminal angioplasty for lower-limb ischemia. Radiology. 1990; 177: 559-564. 4. Krepel V.M., van Andel G.J. et al. Percutaneous transluminal angioplasty of the femoropopliteal arteries: initial and long-term results. Radiology. 1985; 156:25-28. 5. Харазов А Ф. Диагностика и результаты лечения пациентов с критической ишемией нижних конечностей при атеросклеротическом и диабетическом поражении артерий ниже паховой связки. Дис. канд.мед. наук. 2002; 12.
Abstract: Aim: was to determine indications for use of the technique of retrograde recanalization of the occluded portion of the artery through tibial collateral branches. Materials and methods: 71 years old patient, was admitted with complaints of pain at rest in the right foot, cold, lack of sensitivity of fingers of both feet, blackening of hallux of the right foot with ischemic gangrene of 1 toe of right foot. Multislice computed tomography angiography of lower limbs revealed shin artery occlusion on both sides. Regional systolic pressure (RSP) on the right anterior tibial artery (ATA) - 80 mm Hg., (ancle-brachial index (ABI) = 0.55) for posterior tibial artery (PTA) - 50 mm Hg., (ABI = 0.33). Diagnostic angiography: fibular artery and PTA occlusion throughout, occlusion of proximal and middle parts of ATA. We performed retrograde recanalization of the occluded artery of the transcollateral approach Results: ATA patency restored all the way to the foot. RSP to ATA 140 mm Hg., (ABI = 0.9) for PTA RSP was 100 mm Hg., (ABI = 0.6). Conclusions: transcollateral approach is an additional method of revascularization, which increases the rate of technical success after a failed antegrade revascularization, and this method can be an alternative to the retrograde approach. References 1. Carmona G.A., Hoffmeyer P., Hermann F.R. et al. Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Diabetes Metab. 2005; 31: 449-454. 2. Wolfe J.H., Wyatt M.G., Critical and subcritical ischemia. Eur. J. Vase Endovasc. Surg. 1997;13: 578-582. 3. Goshima K.R., Mill J.L. Sr., Hughes J.D. A new look at outcomes after infrainguinal bypass surgery: Traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage. J. Vasc. Surg. 2004 Feb; 39(2): 330-335. 4. Faglia E., Dalla Paola L., et al. 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