Abstract: This review is devoted to critical upper limb ischemia in patients with hemodialysis vascular access. Possible etiological causes of critical ischemia and diagnostic aspects of this pathology are considered. Contemporary approaches of treatment of critical ischemia in this group of patients are demonstrated; indications and contraindications for methods of treatment are discussed. Particular attention has been paid to endovascular method of revascularization of hand, which can become the method of choice in treatment of patients with critical ischemia of the upper limb caused by occlusive lesions of arteries in patients with hemodialysis vascular access. References 1. Vennesland JB, S?reide K, Kval?y JT, et al. A Population-Based Study of Incidence, Presentation, Management and Outcome of Primary Thromboembolic Ischemia in the Upper Extremity. World J Surg. 2019; 43(9): 2320-2327. https://doi.org/10.1007/s00268-019-05023-w 2. Thibaudeau S, Serebrakian AT, Gerety PA, Levin LS. An algorithmic approach to the surgical treatment of chronic ischemia of the hand: а systematic review of the literature. Plast Reconstr Surg. 2016; 137: 818-828. 3. Huber TS, Larive B, Imrey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg. 2016; 64(4): 1050-1058. https://doi.org/10.1016/j.jvs.2016.03.449 4. Horst VD, Nelson PR, Mallios A, et al. Avoiding hemodialysis access-induced distal ischemia. The Journal of Vascular Access. 2020. https://doi.org/10.1177/1129729820943464 5. Mohamed AS, Peden EK. Dialysis-associated steal syndrome (DASS). The Journal of Vascular Access. 2017; 18(1): 68-73. https://doi.org/10.5301/jva.5000684 6. Stolic RV, Trajkovic GZ, Miric DJ, et al. Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis. World J Nephrol. 2013; 2(2): 26-30. https://doi.org/10.5527/wjn.v2.i2.26 7. Cheun TJ, Jayakumar L, Sideman MJ, et al. Upper extremity arterial endovascular interventions for symptomatic vascular access-induced steal syndrome. J Vasc Surg. 2019; 70 (2): 1896-1903. 8. Sedov VM, Karpov SA, Alfyorov SV, Grinyov KM. Phenomenon of ischemic steal syndrome in patients with different arteriovenous fistulas for hemodialysis and its surgical correction. Grekov's Bulletin of Surgery. 2013;172(6): 051-055 [In Russ]. 9. Vaes RHD, Wouda R, Teijink JAW, Scheltinga MR. Venous side branch ligation as a first step treatment for haemodialysis access induced hand ischemia: effects on access flow volume and digital perfusion. Eur J Vasc Endovasc Surg. 2015; 50: 810-814. 10. Tordoir JHM, Dammers R, van der Sande FM.мUpper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg. 2004; 27: 1-5. 11. Gurkov A, Lobov G, Gurevich K. Blood flow in the large vessels of the forearm and in the microvessels of the hand in patients on programmed hemodialysis. The Doctor. 2012; 6: 64-67 [In Russ]. 12. Cheun TJ, Jayakumar L, Sheehan MK et al. Outcomes of upper extremity interventions for chronic critical ischemia. J Vasc Surg. 2018; 69 (1): 20-128. 13. Tursunov BZ, Usmanov HH, Temirov SN. Balloon angioplasty of the radial artery in critical hand ischemia. Angiology and Vascular Surgery. 2018; 24: 64-69 [In Russ]. 14. Guerra A, Raynaud A, Beyssen B, et al. Arterial percutaneous angioplasty in upper limbs with vascular access devices for haemodialysis. Nephrol Dial Transplant. 2002; 17: 843-851. 15. Oprea A, Molnar A, Scridon T, Mircea PA. Digital pressure in haemodialysis patients with brachial arteriovenous fistula. Indian J Med Res. 2019; 149(3): 376-383. 16. Tolba M, Maresch M, Kamal D. Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula. J Surg Case Rep. 2020; 2020(9): rjaa314. https://doi.org/10.1093/jscr/rjaa314 17. Alie-Cusson FS, Bhat K, Ramchandani J, et al. Distal Revascularization and Interval Ligation for the Management of Dialysis Access Steal Syndrome. Ann Vasc Surg. 2021; 74: 29-35. https://doi.org/10.1016/j.avsg.2021.01.102 18. Scali ST, Chang CK, Raghinaru D, et al. Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia. Eur J Vasc Endovasc Surg. 2013; 45:195. 19. De Caprio JD, Valentine RJ, Kakish HB, et al. Steal syndrome complicating hemodialysis access. Cardiovasc Surg. 1997; 5: 648-653. 20. Sheaffer WW, Hangge PT, Chau AH, et al. Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome. J Clin Med. 2018; 7(6): 128. 21. Kordzadeh A, Garzon LAN, Parsa AD. Revision Using Distal Inflow for the Treatment of Dialysis Access Steal Syndrome: A Systematic Review. Ann Vasc Dis. 2018; 11(4): 473-478. 22. Vaes RHD, van Loon M, Selma MM, et al. One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial artery-based hemodialysis vascular access. J Vasc Access. 2015; 16(9): 96-101. 23. Shaikh FA, Siddiqui N, Shahzad N, et al. Operative Techniques to Prevent Dialysis Access-associated Steal Syndrome in High-risk Patients Undergoing Surgery for Hemodialysis Access: A Systematic Review. Cureus. 2019; 11(11): 6086. 24. Schaffer D. A prospective, randomized trial of 6-mm versus 4-7-mm PTFE grafts for hemodialysis access in diabetic patients. In: Vascular Access for Hemodialysis, 5th. ed., edited by Henry ML, Ferguson RM, Tucson, WL. Gore and Associates, Inc., and Precept Press, 1997; 91-94. 25. Scholz H. Arteriovenous Access Surgery. New-York: Springer-Verlag Berlin Heidelberg. 2015. 26. Patel MS, Davies MG, Nassar GM, Naoum JJ. Open repair and venous inflow plication of the arteriovenous fistula is effective in treating vascular steal syndrome. Ann Vasc Surg. 2015; 29(5): 927-933. https://doi.org/10.1016/j.avsg.2014.12.042 27. Zamani P, Kaufman J, Kinlay S. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis. Vascular Medicine. 2009; 14: 371-376. 28. Leake AE, Winger DG, Leers SA, et al. Management and outcomes of dialysis access-associated steal syndrome. J Vasc Surg. 2015; 61(3): 754-760. 29. Misskey J, Yang C, MacDonald S, et al. A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia. J Vasc Surg. 2016; 63(6): 1574-1581. 30. Shakarchi JA, Stolba J, Houston JG, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016; 17(1): 40-46. 31. Spinelli F, Benedetto F, Passari G, et al. Bypass Surgery for the Treatment of Upper Limb Chronic Ischaemia. Eur J Vasc Endovasc Surg. 2010; 39: 165-170. 32. Pederson WC. Revascularization Options for Terminal Distal Ischemia. Hand Clin. 2015; 31: 75-83. 33. Cornejo A, Neaman KC, Srinivasan RC, et al. In situ venous bypass for chronic hand ischemia. Ann plast surg. 2016; 76(4): 275-279. 34. Masden LD, Seruya M, Higgins JP. A systematic review of the outcomes of distal upper extremity bypass surgery with arterial and venous conduits. Hand Surg. 2012; 37(A): 2362-2367. 35. Hoexum F, Coveliers HM, Lu JJ, et al. Thoracic sympathectomy for upper extremity ischemia. Minerva Cardioangiologica. 2016; 64(6): 676-685. 36. Zeng W, Hammert WC. Arterialization of the Venous System for Treatment of Chronic Ischemia in the Hand. Plast Reconstr Surg. 2016; 137(4): 1213-1220. 37. Zatevahin II, Cipciashvili MSh, Gorbenko UF. Тransplantation of omentum major in the treatment of distal lesions of the tibial arteries. Clinical angiology: Manual/Ed. by A.V. Pokrovsky. - Moscow: Medicine Publishers, 2004; 2: 316-325 [In Russ]. 38. Shukla PA, Contractor S, Huang JT, Curi MA. Coil embolization as a treatment alternative for dialysis-associated steal syndrome. Vasc Endovascular Surg. 2012; 46(7): 546-9. https://doi.org/10.1177/1538574412456435 39. Davies MG. Management of Arteriovenous Fistula Side Branches: Ligation or Coil Embolization. Journal of Vascular Surgery. 2019: 70(2): 34. https://doi.org/doi:10.1016/j.jvs.2019.06.041 40. Kasirajan K. Coil Embolization of Tributaries of Brachiocephalic Fistula is Effective in the Management of Vascular Steal. Ann Vasc Surg. 2021; 72: 307-314. https://doi.org/10.1016/j.avsg.2020.08.150 41. 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(5): 717-22. https://doi.org/10.1177/1526602816659279 42. Law Y, Chan YC, Cheng SW. Angioplasty of forearm arteries as a finger salvage procedure for patient with end-stage renal failure. Int J Nephrol Renovasc Dis. 2016; 9: 105-109. https://doi.org/10.2147/IJNRD.S102257 43. Gandini R, Angelopoulos G, Da Ros V, et al. Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: the radial to ulnar artery loop technique. J Vasc Surg. 2010; 52: 760-762. 44. Singh A, Kumar N, Jain AP, et al. Endovascular management of critical hand ischemia by 'palmar arch loop' technique. Vascular. 2021; 29(4): 597-605. https://doi.org/10.1177/1708538120966939 45. Bahro A, Igyarto Z, Martinsen B. Critical hand ischemia treatment via orbital atherectomy - A single center observational retrospective analysis. Cardiovascular Revascularization Medicine. 2017; 18: 91-94. 46. Gandini R, Fabiano S, Morosetti D, et al. Endovascular treatment of below-the-elbow arteries in critical hand ischemia. Minerva Cardioangiol. 2016; 64(6): 662-71. 47. Yeager RA, Moneta GL, Edwards JM, et al. Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease. J Vasc Surg. 2002; 36(2): 245-249.
Abstract We performed an analysis of literature data about angiosome concept in treatment of patients wih critical lower limb ishemia. We presented data on the appearance and development of this concept. Possibilities of using this tactic in various situations are considered, advantages and disadvantages of this concept are shown. Factors, limiting the effectiveness of this method, and alternative methods when it is impossible to restore blood flow according to the angiosome concept - the degree of lesion of arteries and the development of collateral blood flow to restore perfusion of soft tissues are given. It has been shown that the correct assessment of collateral arteries in critical lower limb ischemia plays a central role in any type of lower limb revascularization, and this statement also applies to a strategy based on the angiosome concept. Refereneces 1. Diabetes: Newsletter. No. 312 [Electronic resource]. Vsemirnaya Organizaciya Zdravoohraneniya. ZHeneva,2011. Rezhim dostupa: www.who.int/mediacentre/ factsheets/fs312/ru/index.html. Data dostupa: 31.03.11. [In Russ.] 2. Wild S et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004. Vol. 27. P. 1047-1053. 3. Sachek M.G., Bulavkin V.P., Eroshkin S.N. Possibilities of direct limb revascularization in treatment of patients with diabetic foot syndrome. Novosti hirurgii tom 19. №4.2011. [In Russ.] 4. Ancyferov M. B. i dr. Prophylaxis system of lower limb' amputations in patients with diabetes mellitus and prospects for its implementation in 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; 33Suppl 1:S32-55 S. 6. Mitchell ME: lower extremity major amputations. In: Diabetic foot, lower extremity arterial disease and limb salvage. 7. Eroshkin S.N.. Long-term results of treatment of patients with purulent-necrotic forms of diabetic foot syndrome, depending on used methods of revascularization. Novosti hirurgii tom 21. № 4. 2013. [In Russ.] 8. Ikonen T.S., Sund R., Venermo M., Winell K.: Fewer major amputations among individuals with diabetes in 9. 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;33:453-460. 10. Lepantalo M., Apelqvist J., Setacci C., et al: Chapter v: Diabetic foot. Eur J Vasc Endovasc Surg. 2011;42 Suppl 2: S60-74. 11. Alexandrescu V., Sцderstrцm M., Venermo M. Angiosome theory: fact or fiction? Scandinavian Journal of Surgery 101: 125-131, 2012. 12. Lepantalo M., Biancari F, Tukiainen E.: never amputate without consultation of a vascular surgeon. Diabetes Metab Res Rev2000;[16]: Suppl 1: S27-32 13. 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. doi: 10.1016/j.jvs.2008.08.036. 14. Romiti M, Albers M, Brochado-Neto FC, et al. Metaanalysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008;47(5):975-981. doi: 10.1016/j.jvs.2008.01.005. 15. Bondarenko O.N., Galstyan G.R., Ayubova N.L., i dr. Outcomes of endovascular interventions in patients with diabetes mellitus and critical lower limb ischemia. Sbornik tezisov. VI Vserossijskij diabetolgicheskij kongress. M.:2013. S 170. [In Russ.] 16. Soderstrom M, Arvela E, Alback A, Aho PS, lepantalo M: Healing of ischaemic tissue lesions after infrainguinal bypass surgery for critical leg ischaemia. Eur J Vasc Endovasc Surg 2008;36:90-9515. 17. 18. Berceli S.A.. Chan A.K.. Pomposelli F.B. ct al. Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers. J. Vase. Surg. 1999. Vol. 30. X» 3. P 499-508. 19. Taylor GI, Palmer JH: The vascular territories [angiosomes] of the body: experimental studies and clinical applications. Br J Plast Surg 1987;40:113-141. 20. Taylor GI, Pan WR: Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 1997;4:183-198. 21. Attinger CE, Evans KK, Bulan E, Blume P, Cooper P Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization Plast. Reconstr. Surg. 117 (Suppl.): 261S, 2006. 22. Neville RF, Attinger CE, Bulan EJ, et al: Revascularization of a specific angiosome for limb salvage: does the target artery matter? Ann Vasc Surg 2009;23[3]: 367-7320. 23. Varela C, Acin nF, Haro JD, 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 Endovasc Surg 2010;44:654-660. 24. 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The Impact on Wound Healing and Major Amputation-free Survival in Patients With Isolated Below-the-Knee Arterial Disease After Angiosome-Directed Endovascular Revascularization Journal of Vascular Surgery August 2018, Volume 68, Issue 2, Page e24. 32. Elbadawy A, Ali H, Saleh M, Hasaballah. A Prospective Study to Evaluate Complete Wound Healing and Limb Salvage Rates After Angiosome Targeted Infrapopliteal Balloon Angioplasty in Patients with Critical Limb Ischaemia A. Eur J Vasc Endovasc Surg 2018;55:391-6. 33. Doherty TM, Fitzpatrick LA, Inoue D, et al. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocr Rev. 2004;25(4):629-672. doi: 10.1210/ er.2003-0015. 34. Dedov I.I., Anciferov M.B., Galstyan G.R., i dr. Diabetic foot syndrome. M.: «Universum Pablishing»; 1998. [In Russ.] 35. Shanahan CM1, Cary NR, Salisbury JR, et al. 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Abstract: The purpose of the study is to evaluate the immediate and long-term effectiveness of percutaneous transluminal angioplasty (PTA) in patients with diabetes mellitus (DM) and critical lower limbs ischemia (CLLI). Since November 2004 till February 2008 42 PTA were performed in 40 patients with CLLI; 28 (70%) of them had ischemic ulceration, in 6 patients (15%) there were foot gangrene, and 6 patients suffered of ischemic rest pain. 30 patients (75%) had the insulin-dependent DM, 8 patients (20%) took antihyperglycemic drugs, 2 (5%) kept to antihyperglycemic diet. There were the following comorbidities: CAD - 30 patients (75%); arterial hypertension - 31 (77,5%); cerebrovascular insufficiency - 15 (37,5%); chronic renal failure - 8 (20%), and 3 patients (7,5%) were on chronic hemodialisis. One patient (1,4%) had iliac localization of the lesion, 38 (51,4%) - femoropopliteal disease, and there were infrapopliteal lesions in 35 (47,3%) patients. There were prevalence of TASC type C and type D lesions (89,2%), and 81,5% of all infrapopliteal lesions were occlusions. Subintimal tracking was used in 31,5% of lesions. Stenting performed in 2 cases. Angiography success rate was 92,7% - 37 patients. Clinical improvement registered in 36 (90%) patients. 12-month follow-up showed absence of critical ischemia in 72,8% of cases.
Reference 1. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur. J. Vasc. Endovasc. Surg. 2007; 33 (1): 39. 2. Jonason T., Ringqvist I. Factors of prognosticimportance for subsequent rest pain in patient with intermittent claudication. Acta. Med.Scand. 1985; 218: 27-33. 3. Hughson W.G., MannJ.I., Garrod A. Intermittent claudication: prevalence and risk factors,tent claudication: prevalence and risk factors. Br. Med.J. 1978; 1: 1379-1381. 4. LoGerfo F.W., Gibbons G.W., PomposelliJ.F.B., Campbell D.R., Miller A., Freeman D.V.et al. Trends in the care of the diabetic foot.Expanded role of arterial reconstruction. Arch. Surg. 1992; 127: 617-620. 5. Blair J.M., Gewertz B.L., Moosa H., Lu C.T.,Zarins C.K. Percutaneous transluminal angioplasty versus surgery for limb-threateningischemia.J. Vasc. Surg. 1989; 9 (5): 698-703. 6. Treiman G.S., Treiman R.L., Ichikawa L., Van Allan R. Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?J. Vasc. Surg. 1995; 22 (4): 457-463, 464-465. 7. Parsons R.E., Suggs W.D., Lee J.J., Sanchez L.A., Lyon R.T., Veith F.J. Percutaneous transluminal angioplasty for the treatment of limbthreatening ischemia: do the results justify anattempt before bypass grafting? / Vase. Surg. 1998; 28 (6): 1066-1071. 8. Molloy K.J., Nasim A., London N.J., Naylor A.R., Bell PR., Fishwick G., Bolia A., Thornpson M.M. Percutaneous transluminal angioplasty in the treatment of critical limb ischemia.J. Endovasc. Ther. 2003; 10 (2): 298-303. 9. Nasr M.K., McCarthy R.J., Hardman J., Chalmers A., Horrocks M. The increasing role ofpercutaneous transluminal angioplasty in theprimary management of critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2002; 23 (5):398-403. 10. Adam D.J., Beard J.D., Cleveland T.T. Bypassversus angioplasty in severe ischaemia of theleg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366 (9501):1925-1934. 11. Faglia E., DallaP.L., Clerici G., ClerissiJ., Gra ziani L., Fusaro M., Gabrielli L., Losa S., Stella A., Gargiulo M., Mantero M., Caminiti M., Ninkovic S., Curci V., Morabito A. Peripheral angioplasty as the first-choice revascularization 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. 12. Bolia A., Miles K.A., Brennan J. et al. Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by dissection. Cardiovasc. Intervent. Radiol. 1990; 13: 357-363. 13. Rutherford R.B., Baker J.D., Ernst C., Johnston K.W., PorterJ.M., Ahn S.,Jones D.N. Recommended standards for reports dealing with lower extremity ischemia: revised version. [Erratum in: / Vase. Surg. 1997; 26 (3): 517-538.] J. Vasc. Surg. 2001; 33 (4): 805. 14. Капутин М.Ю., Овчаренко Д.В., Сорока В.В. и др. Субинтимальная ангиопластика в лечении больных с критической ишемией нижних конечностей. Медицинский академический журнал. 2007; 6 (3): 103-108. 15. Graziani L., Silvestro A., Bertone V., Manara E., Alicandri A., Parrinello G., Manganoni A. Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease. Nephrol. Dial. Transplant. 2007; 22 (4): 1144-1149. 16. Graziani L., Silvestro A., Bertone V., Manara E., Andreini R., Sigala A., Mingardi R., De Giglio R. 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. 17. Long-term mortality and its predictors in patients with critical leg ischaemia. The I.C.A.I. Group (Gruppo di Studio dell'Ischemia Cronica Critica degli Arti Inferiori). The Study Group of Criticial Chronic Ischemia of the Lower Exremities. Eur. J. Vasc. Endovasc. Surg. 1997; 14 (2): 91-95.
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.
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Abstract: A group of patients, including 88 diabetics and 93 non-diabetics (patients were diagnosed according to A. Bollinger system) was studied in terms of occlusive-stentic lesions. The occlusive-stentic affection of low-extremities combined with diabetes is characterized by a number of distinctive features. The majority of diabetics are suffering the distal type of arterial lesion, while atherosclerotics suffer the proximal type. Diabetes functions as a complicating factor, forcing the development of occlusive-stentic process largely in distal segments of low extremities, meaning popliteal and crural arteries. This process eventually leads to the ischemia of low extremities. References 1. Gensler S.W, Haimovici H, Hoffert P., Steinman С, Beneventano Т.С. Study of vascular lesions in diabetic, nondiabetic patients. Clinical, arteriographic, and surgical considerations. Arch. Surg. 1965; 91:617 - 622. 2. Haimovici H. Patterns of arteriosclerotic lesions of the lower extremity. Arch. Surg. 1967; 95:918 - 933. 3. Conrad M.C. Large and small artery occlusion in diabetics and nondiabetics with severe vascular disease. Circulation. 1967; 36:83 - 91. 4. Bollinger A., Breddin K., Hess H., Heystraten F.M.J., Kollath J., Kontilla A., Pouliadis G., Marshall M., Mey Т., Mietaschk A., Roth F.-J. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis. 1981; 38: 339-346. 5. Van der Feen C, Neijens F.S., Kanters S.D.J.M., Mali WP.Th.M., Stolk R.P., Banga J.D. Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes. Diabetic Medicine. 2002;19:366-370. 6. Покровский А.В., Дан В.Н., Чупин А.В.. Ишемическая диабетическая стопа. Синдром диабетической стопы. Клиника, диагностика, лечение и профилактика. Москва. 1998; 18 - 35. 7. Балаболкин М.И.. Эндокринология. М.: Универсум паблишинг. 1998; 421, 423. 8. Атанов Ю.П., Шамычкова А.А.. Диабетическая ангиопатия нижних конечностей. Российский медицинский журнал. 2001;5: 14- 15. 9. Donnelly R. Vascular complications of diabetes. B.M.J. 2000; 320:1062- 1066. 10. Faglia E. et al. Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. Journal of Internal Medicine. 2002; 252: 225 - 232 11. Awad S., Karkos CD., Serrachino-Inglott E, Cooper N.J., Butterfield J.S., Ashleigh R., Nasim A. The impact of diabetes on current revascularisation practice and clinical outcome in patients with critical lower limb ischaemia. European journal of vascular and endovascular surgery. 2006; 32 (1): 51-59. 12. Bosiers M, Hart J.P, Deloose K., Verbist J., Peeters P. Endovascular therapy as the primary approach for limb salvage in patients with critical limb ischemia: experience with 443 infrapopliteal procedures. Vascular. 2006; 14 (2):63 - 69.
Abstract: Article presents the results of analysis of risk factors associated with early stent thrombosis after percutaneous coronary intervention (PCI) ir patients with acute myocardial infarction (AMI). The study is designed as an observational cohort study prospectively including 140 patients with a PCI treated AMI admitted to our hospital. Patients were divided into two groups: with and without type 2 diabetes rnellitus (DM). A number of early stent thrombosis risk factors including a complete or not complete revascularization and myocardial blush grade during PCI, based on the predictive model were analyzed. The results of the study show that DM in patients with AMI who underwent PCI was not associated with a high risk of early stent thrombosis, however, incomplete revascularization was. References 1. Iakovou I., Schmidt T., Bonizzoni E., et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293: 2126-2130. 2. McFadden E. P., Stabile E., Regar E., et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004; 364: 1519-21. 3. Virmani R., Guagliumi G., Farb A., et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation. 2004; 109: 701-5. 4. Keith A.A., Philippe Gabriel Steg., Kim A. Eagle, et al. For the GRACE investigators decline in rates of death and heart failure in acute coronary syndromes. JAMA. 2007; 297: 1892-1900. 5. Iakovou I., Schmidt T., Bonizzoni E., Ge L. et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293(17): 2126-30. 6. Carr M. E. Diabetes mellitus: a hypercoagulable state. J. Diabetes Complications. 2001; 15: 44-54. 7. Georgios Sianos, Marie-AngMe Morel, Arie Pieter Kappetein The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. Eurolnterv. 2005; 1: 219-227. 8. Petrosjan Ju S, Ioseliani D G. O summarnoj ocenke sostojanija koronarnogo rusla u bol'nyh ishemicheskoj bolezn'ju serdca. [Complex estimation of coronary arteries condition in patients with CAD.]. Kardiologija. 1976; 12(16): 41-46 [In Russ]. 9. Svilaas T. Thrombus aspiration during primary percutaneous coronary intervention. N. Engl. J. Med. 2008; 358: 557. 10. Mauri L., Hsieh W., Massaro J. M. et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N. Engl. J. Med. 2007; 356: 1020-9. 11. Rebrova O. Ju. Statisticheskij analiz medicinskih dannyh. [Statistic analysis of medical data]. Izd. Media Sfera. Moskva. 2003 [In Russ]. 12. Cockcroft D. W., Gault M. H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16: 31-41. 13. Norhammar A., Malmberg K., et al. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J. Am. Coll. Cardiol. 2004; 43(4): 585-91. 14. Haim D. Danenberg, Greghana Marincheva, Boris Varshitzki, Hisham Nassar, Chaim Lotan Stent Thrombosis: A Poor Man's Disease? IMAJ. 2009; 11: 529-532. 15. Isaac Moscoso, Lazaro Claudiovino Garcia, Gilvan Oliveira Dourado, et al. Influence of Diabetes Mellitus on Immediate Results of Coronary Stent: 16. Aoki J., Lansky A. J., Mehran R. et al. Early stent thrombosis in patients with acute coronary syndromes treated with drug-eluting and bare metal stents: the Acute Catheterization and Urgent Intervention Triage Strategy trial. Circulation. Febr. 10, 2009; 119(5): 687-98. 17. Shaw R. E., Anderson. V., Brindis R.G. Development of a risk adjustment mortality model using the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) Experience: 1998-2000. J. Am. Coll. Cardiol. 2002; 39: 1104-12.
Abstract: Aim: was to evaluate morphological features of lesions in lower limb arteries before percutaneous transluminal angioplasty (PTA) and its arterial complications in patients with critical lower limb ischemia (CLI) combined with diabetes mellitus(DM). Materials and methods: for the period from September 2010 to June 2013, a prospective single-center study was conducted involving 171 patients with CLI and DM (80(47%) men, mean age 64,1[54-68] years, mean HbA1c 8,3[7,4-9,6]%, mean duration of diabetes 16,5[8-23] years, diabetes type 1/2-18/153) who underwent PTA in 193 lower limbs. Myocardial infarction and brain stroke in anamnesis had 53(31%) and 19(11%) patients, respectively Chronic kidney disease (CKD) 3-4 stages had 40 patients(24%), end-stage renal disease - 16 cases (10%). Diagnosis of CLI was based on recommendation of TASC II. Patency of arteries of lower limbs was evaluated by duplex ultrasound (DU) before PTA and during early follow-up period (30 days). PTA in all patients was considered technically successful in restoring continuous arterial flow to the foot of at least one crural artery without residual stenosis >50%. Results: stenosis>50% and occlusions of tibial arteries were found in all patients. Peripheral arterial disease 4-6 classes according Graziani L. classification was marked in 180(93%) cases. Extensive tibial arterial calcification was found in 123(64%) cases, in patients with residual stenosis (> 50% remaining diameter) -113 (89%). The mean value of transcutaneous oxygen pressure (tcpO2) before PTA was 14,7(8-25) mmHg, after PTA - 35,2 (31-38) mmHg. After PTA , residual stenosis (>50%) in treated arteries was in 125(79,1%) cases, thrombosis in treated arteries - 9(5,7%), intimal dissection - 18(11,4%), incomplete stent disclosure - 3(1,9%), incomplete capture stent area stenosis - 2(1,3%), dislocation of the stent - 1(0,6%). Repeat PTA in the early follow-up period was performed in 15 patients with clinically significant complications (6%). Conclusion: CLI in diabetic patients is characterized by having severe morphological lesions of lower limb arteries, infrapopliteal arterial calcification. DU plays important role in evaluation of arterial patency and PTA complications in early follow-up period. The high level of residual stenosis of tibial arteries after PTA is associated with chronic complications of diabetes mellitus, including renal insufficiency Timely reintervention in diabetic patients with clinical significant PTA complications promotes optimal arterial patency and permission of CLI in theese cases. Reference 1. Ajubova N.L., Bondarenko O.N., Galstjan G.R., Manchenko O.V., Dedov 1.1. Osobennosti porazhenija arterij nizhnih konechnostej i klinicheskie ishody jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom s kriticheskoj ishemiej nizhnih konechnostej i hronicheskoj pochechnoj nedostatochnost'ju [Peculiarities of arteries' lesions of lower limb, and clinical outcomes of PCI in patients with critical ishemia of lower limbs with diabetes mellitus and chronic renal insufficiency]. Saharnyj diabet. 2013; 4:85-94 [In Russ]. 2. TASC. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J.Vasc Surg., 2000;31(1 part2):S1-287. 3. Lumley J.S. Vascular management of the diabetic foot- a British view. Journal Annals of the Academy of Medicine, Singapore. 1993, Vol 22, N 6, P 912-6 4. M.Doherty T., Lorraine A.F., Inoue D., Jian-Hua Qiao, M.C.Fishbein, R.C.Detrano, PK.Shan, T.B. Rajavashisth. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocrine Reviews. 2004, 25 (4):629-672 5. Bublik E.V., Galstjan G.R., Mel'nichenko G.A., Safonov V.V., Shutov E.V., Filipcev P.Ja. Porazhenija nizhnih konechnostej u bol'nyh saharnym diabetom s terminal'noj stadiej hronicheskoj pochechnoj nedostatochnosti, poluchajushhih zamestitel'nuju pochechnuju terapiju [Lower limbs’ lesions in patients with diabetesmellitus with end-stage chronic renal insufficiency, receiving replacement therapy]. Saharnyj diabet. 2008; 2: 17-23 [In Russ]. 6. Jager K.A., Phillips D.J., Martin R.L., Hanson C., Roederer G.O., Langlois YE. et al. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med. Biol. 1985;11: 515-21. 7. Ciaverella A., Silletti A., &Mustacchio A., et al. Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischemia. Diabet. Metab. 1993;19:586-589. 8. Jude E.B., Oyibo S.O. & Chalmers N., et al. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433-1437. 9. Bandyk D.F. Surveillance after lower extremity arterial bypass. perspect vasc surg endovasc ther. Eur Heart J. 2007;19:376-83. 10. Faglia E., Mantero M. & Caminiti M. et al. Extensive use of peripheral angioplasty, especially infrapopliteal, in the treatment of ischemic foot ulcer: clinical results of a multicentric study of 221 consecutive diabetic subjects. J. Intern. Med. 2002; 252:225-232. 11. Adam D.J., Beard J.D., Cleveland T., Bell J., Bradbury A.W., Forbes J.F. et al.; BASIL Trial Participants. Bypass versus Angioplasty in Severelschaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366:1925-34. 12. Norgen L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes FGR. Inter-society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 45(Suppl S):S5-67. 13. Hirsch A.T., Haskal Z.J., Hertzer N.R., Bakal C.W., Creager M.A., Halperin J. et al; American Association for Vascular Surgery/Society for Vascular Surgery;Society for Cardiovascular Angiography and Interventions;Society for Vascular Medicine and Biology; Society for Inerventional Radiology; ACC/AHA TASC Force on Practice Guidelines. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower exteremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA TASC Forc on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. Circulation. 2006 113: e463-654, 14. Dick F., Ricco J.B., Davies A.H.: Chapter VI: Follow-up after Revascularisation. Eur. J. Vasc. Endovasc. Surg. 2011; 42: S75-S90. 15. Bondarenko O.N., Ajubova N.L., Galstjan G.R., Dedov 1.1. Dooperacionnaja vizualizacija perifericheskih arterij s primeneniem ul'trazvukovogo dupleksnogo skanirovanja u pacientov s saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej [Preoperative visualization of peripheral arteries with the help of ultrasonic duplex scanning in patients with critical ischemia of lower limbs and diabetes mellitus]. Saharnyj diabet. 2013; 2: 52-61 [In Russ]. 16. Arvela E., Dick F: Surveillance after Distal Revascularization for Critical Limb Ischemia. Scandinavian Journal of Surgery. 2012; 101:119-124. 17. Diehm N., Baumgartner I., Jaff M., Do D.D., Minar E., Schmidli J. et al. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischemia of lower limb arteries. Eur. Heart J. 2007; 28: 798-805.
Abstract: Aim: was to analyze long-term results of coronary artery stenting with drug-eluting stents «Zotarolimus» and bare metal stents in patients with a concomitant diabetes mellitus type II. Materials and methods: 37 patients with ischemic heart disease and concomitant diabetes mellitus type II were selected for analysis; they underwent implantation of stents without drug coverage («Intergrity» «Medtronic») or stents with drug-eluting «Zotarolimus» («Resolute Integrity» «Medtronic»). All patients were divided into 2 groups: first group consisted of 11 patients, who underwent implantation of bare metal stents, second group - 26 patients who underwent implantation of drug-eluting stents, «Zotarolimus». Follow-up period was 26±4 months. Criteria of stenting efficiency were: angiographic assessment of coronary arteries anatomy in control angiography after stent implantation, reccurence of angina or functional class increase, the survival rate in the nearest postoperative period, before discharge, but not more than 30 days, and in the early post-operative period up to 6 months. In the medium-distant post-operative period - 12 months, and in the late postoperative period - 24 months. Results: all patients underwent successfully performed endovascular revascularization. The optimal angiographic result was achieved in all patients. Regression of ischemic changes on ECG data and increase myocardial contractility by echocardiography data also were marked in all patients. In long-term follow-up period, in 5 (45%) patients with bare metal stents we noted the appearence of hemodynamically significant restenosis, that needed performance of secondary angioplasty with stenting. Conclusion: the use of antiproliferative drug-eluting stents «Zotarolimus» is possible in treatment of patients with coronary artery disease and comorbid diagnosis of diabetes mellitus type II. Bare metal stents in coronary stenting in patients with concomitant diagnosis of diabetes mellitus type II is impractical due to developing in-stent restenosis (45% of patients). References 1. Kereiakes D.J., Cutlip D.E., Applegate R.J., Wang J., Yaqub M., Sood P., Su X., Su G., Farhat N., Rizvi A., Simonton C.A., Sudhir K., Stone G.W. Outcomes in diabetic and nondiabetic patients treated with everolimus- or paclitaxel-eluting stents: results from the SPIRIT IV clinical trial (Clinical Evaluation of the XIENCE V Limus Eluting Coronary Stent System). J. Am. Coll. Cardiol. 2010 Dec 14; 56(25):2084-2089. 2. Petrova K.N., Kozlov S.G., Ljakishev A.A., Savchenko A.P. Vlijanie saharnogo diabeta 2 tipa na rezul'taty jendovaskuljarnogo lechenija IBS s pomoshhju stentov s lekarstvennym pokrytiem (dannye godichnogo nabljudenija) [Influence of diabetes mellitus type 2 on results of endovascular treatment of IHD with help of drug-eluting stents (data monitoring for one year)]. Kardiohgija. 2006; 12: 22-6 [In Russ]. 3. Abizaid A., Costa M.A., Blanchard D. et al. Sirolimus-Eluting Stents Inhibit Neointimal Hyperplasia in Diabetic Patients. Insights from the RAVEL Trial. Eur. Heart J. 2004; 25: 107-12. 4. Moussa I., Leon M.B., Baim D.S. et al. Impact of Sirolimus-Eluting Stents on Outcome in Diabetic Patients. Circulation .2004; 109: 2273-8. 5. Hermiller J.B., Raizner A., Cannon L. et al. TAXUS-IV Investigators. Outcomes With the Polymer-Based Paclitaxel-Eluting TAXUS Stent in Patients With Diabetes Mellitus: the TAXUS-IV trial. JACC. 2005; 45: 1172-9. 6. Sabate M., Jim Onez-Quevedo P., Angiolillo D.J. et al. Randomized Comparison of Limus-Eluting Stent Versus Standard Stent for Percutaneous Coronary Revascularization in Diabetic Patients. Circulation. 2005; 112: 2175-83. 7. Jensen J., Lagerqvist B., Aasa M., Sarev T., Nilsson T., Tornvall P. Clinical and angiographic follow-up after coronary drug-eluting and bare metal stent implantation. Do drug-eluting stents hold the promise? J. Intern. Med. 2006 Aug; 260(2):118-24. 8. Jain A.K., Lotan C., Meredith I.T., Feres F., Zambahari R., Sinha N., Rothman M.T. E-Five Registry Investigators. Twelve-month outcomes in patients with diabetes implanted with a zotarolimus-eluting stent: results from the E-Five Registry. Heart. 2010 Jun; 96(11):848-53. doi: 10.1136/hrt.2009.184150. 9. Stettler C., Allemann S., Egger M. et al. Efficacy of drug eluting stents in patients with and without diabetes mellitus: indirect comparison of controlled trials. Heart. 2006; 92: 650-7. 10. Scheen A.J., Warzee F. Diabetes Is Still a Risk Factor for Restenosis After Drug-Eluting Stent in Coronary Arteries. Diabetes Care. 2004; 27: 1840-1. 11. Park K.W., Lee J.M., Kang S.H., Ahn H.S., Kang H.J., Koo B.K., Rhew J.Y, Hwang S.H., Lee S.Y, Kang T.S., Kwak C.H., Hong B.K., Yu C.W., Seong I.W., Ahn T., Lee H.C., Lim S.W., Kim H.S. Everolimus-eluting xience v/promus versus zotarolimus-eluting resolute stents in patients with diabetes mellitus. JACC. Cardiovasc. Interv. 2014 May;7(5):471-81. doi: 10.1016/j.jcin.2013.12.201.
