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. Iida o, nanto S, Uematsu M, et al: Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia. Catheter Cardiovasc Interv 2010;75:830-836. 25. Iida О, 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;55:363-370. 26. Soderstrom, M., Alback, A., Biancari, F., Lappalainen, K., Lepantalo, M., and Venermo, M. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg. 2013; 57: 427-435. 27. Biancari F , Juvonen T. Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. European journal of vascular and endovascular surgery volume 47. Issue 5 p. 517e522 2014. 28. Huang Tzu-Yen, Huang Ting-Shuo, MD, PhD, et al, Direct revascularization with the angiosome concept for lower limb ischemia. A Systematic Review and Meta-Analysis.Medicine 94(34):e1427. 29. Bosanquet D.C., Glasbey J.C.D., Williams I.M., Twine C.P. Systematic Review and Meta-analysis of Direct Versus Indirect Angiosomal Revascularisation of Infrapopliteal Arteries European Journal of Vascular and Endovascular Surgery Volume 48 Issue 1 p. 88e97 July/2014. 30. Azuma N, Uchida H, Kokubo T, Koya A, Akasaka n, Sasajima T: 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: 322-328. 31. Iram Naz, Kaitlyn M. Dunphy, BS, et al . 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. Medial localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis: evidence for smooth muscle cell-mediated vascular calcification. Circulation. 1999; 100(21 ):2168-2176. doi: 10.1161/01.CIR.100. 21.2168. 36. Ayubova N.L., Bondarenko O.N., Galstyan G.R. i dr. Features of lesions of lower limb’ arteries and clinical outcomes of endovascular interventions in patients with diabetes mellitus with critical ischemia of lower limbs and chronic kidney disease. Saharnyj diabet. 2013. T. 16. №4 S.85-94. [In Russ.] 37. Bondarenko O.N., Galstyan G.R., Dedov I.I. Clinical features of critical lower limb ischemia and the role of endovascular revascularization in patients with diabetes mellitus. 2015;18(3):57-69. [In Russ.] 38. O’neal lW: Surgical pathology of the foot and clinicopathologic correlations. In: levin and o’neal’s The Diabetic Foot. Philadelphia, Mosby Elsevier 2008:367-401. 39. Simons JP, Goodney PP, nolan BW, et al: Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia. J Vasc Surg 2010;51[6]: 1419-1424. 40. Khan MU, lall P, Harris lM, et al: Predictors of limb loss despite a patent endovascular-treated arterial segment. J Vasc Surg 2009;49[6]:1445-1446. 41. Platonov S. A., Kaputin M. YU., Ovcharenko D. V.. CHistyakov S. P., Voronkov A. A., Zavackij V. V., Dudonov
Abstract: Purpose: on the basis of long-term results of renal angioplasty and stenting, the authors define the indications for endovascular interventions in patients with renovascular hypertension (RVH). Materials and methods: since 1992-2008 in Tashkent Medical Academy Vascular Surgery Center were performed 131 endovascular interventions in 119 patients for renal arteries (RA) stenoses of various origins. 97 patients underwent balloon angioplasty (BA) of renal arteries (105 interventions), and stenting was performed in 22 cases (26 stenting procedures). Systolic blood pressure varied from 170 to 300 mm Hg (219,4±23,1 mmHg), with diastolic blood pressure from 170 to 300 mm Hg (118,1±8,9 mm Hg). Average arterial hypertension history was 5,2±3,7 years (6 months - 16 years). Results: technical success rate was 85,6% for balloon angioplasty, and 100 % for stenting procedures. Immediate hypotensive effect was good to satisfactory. Complication rate was 2,5% (3 patients). Long-term results were assessed in 76 cases of balloon angioplasty (78,4%), and in all patients with renal arteries stenting. The average follow-up was 72±32,5 months (6-144 months) for balloon angioplasty, and 6-24 months for stenting group. In the angioplasty group long-term hypotensive effect lasted in 54(71,1%) of patients, and the restenosis rate was as high as 28,9% (22 cases). In the stenting group, the long-term hypotensive effect was preserved in all the patients, and there were no cases of restenosis. Conclusions: high rates of technical and clinical success, as well as low rates of restenosis, allow the renal artery stenting procedure to be seen as the method of choice for renovascular hypertension. References 1. Клиническая ангиология в 2 томах. Под редакцией А.В. Покровского. М.: Медицина. 2004; 2: 94-114. 2. Алекян Б.Г., Бузиашвили Ю.И., Голухова Е.З. и др. Ближайшие и отдаленные результаты стентирования почечных артерий у больных с вазоренальной гипертензией. Ангиология и сосудистая хирургия. 2006;1: 55-62. 3. Carmo M., Bower T.C. Surgical мanagement of renal fibromuscular dysplasia. Challenges 11.in the endovascular era. Ann. Vasc. Surgery. 2005; 19: 208-217. 4. Baert A.L., Wilms G., Amery A., Vermylen J.,Suy R. Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients. Cardiovasc. Intervent. Radiol. 1990; 13: 22-28. 5. WongJ.M., Hansen K.J., Oskin T.C. et al. Surgery after failed percutaneous renal artery angioplasty.J. Vasc. Surg. 1999; 30: 468-483. 6. Yutan E., Glickerman D.J., Caps M.T. et al.Percutaneous transluminal revascularizationfor renal artery stenosis. Veterans affairs puget sound health care system experience. J. Vasc. Surg. 2001; 34: 685-693. 7. Петровский Б.В., Гавриленко А.В. 40-летний опыт реконструктивных операций при вазоренальной гипертензии. Ангиология и сосудистая хирургия. 2003; 2: 8-12. 8. Троицкий А.В., Елагин О.С., Хабазов Р.И. и др. Одномоментная реконструкция висцеральных ветвей аорты и почечных артерий. Ангиология и сосудистая хирургия. 2006; 2: 132-136. 9. Крылов В.П., Реут Л.И., Дергачева И.М. и соавт. Отдаленные результаты хирургического лечения вазоренальной гипертензии. Клиническая кардиология. 2004; 2: 34-39. 10. Bonelli F.S., McKusick M.A., Textor S.C. et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo. Clinic. Proc. 1995; 70: 1041-1052. 11. Surowiec S.M., Sivamurthy N., Rhodes J.M. et al. Percutaneous therapy for renal artery fibromuscular dysplasia. Ann. Vasc. Surg. 2003; 17: 650-655. 12. Galaria I.I., Surowiec S.M., Jeffrey M. Percutaneous and оpen renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surg. 2005; 25: 218-224.
Abstract: Article describes the clinical case of a patient suffering from Takayasu's disease and stenotic lesion of the renal artery with early restenosis of renal artery after stenting, causes of mistakes in diagnosis and choice of treatment are also discussed. References 1. Клиническая ангиология. Под ред. акад. Покровского А.В. Москва. М., 2004; т. 1, с.697-734 2. Caps M.T., Zierler R,E.,Polissar N.L. e.a. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int.1998; 53 (3):735-742. 3. Olin J.W., Melia M., Young J.R. e.a. Prevalens of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Amer.J.Med. 1990; .88 (1):46-51. 4. Sharma S.,Gupta H.,Saxena A. Results of renal angioplastic in nonspecific aortoarteritis (Taka- yasu disease). J. Vasc. Interv. Radiol. 1998; 9:429-435. 5. Pokrovsky A.V., Sultanaliev T,A., Spiridonov A.A. Surgical treatment of vasorenal hypertension in nonspecific aortoarteritis (Takayasu disease). J.Cardiovasc. Surg. 1983; 24(1):111-118. 6. Keiffer E., Piquois A., Bertal A. B. Reconstructive surgery of the renal arteries in Takayasu”s disease. Ann.vasc.surg. 1990; 4: 156-165. 7. Liang P., Hoffman G.S. Advances in the medical and surgical treatment of Takayasu”s arteritis. Curr. Opin. Rheumatol.2005;17(1): 16-24. 8. Ковалев И.А., Варваренко В.И., Мурзина О.Ю. Случай неспецифического аортоартериита у ребенка 3 лет. Педиатрия. 2005; 2:.88-90. 9. Suk-Hee Yoo, Gi-Hyun Kim, Won-Ick Lee Successful percutaneous renal artery angioplasty and stenting for acute renal failure in a solitary functioning kidney caused by Takayasu”s arteritis. Korean Circ. J. 2010; 40(2): 414-417. 10. Вачев А.Н., Сухоруков В.В., Фролова Е.В. Хирургическое лечение больного молодого возраста с артериальной гипертензией при неспецифическом аортоартериите с поражением почечных артерий. Ангиология и сосудистая хирургия. 2011; 4: 148-151.
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. 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: 620-627. 5. Norgren L., Hiatt W.R., Dormandy J.A. et al. Intersociety consensus for the management of peripheral arterial disease (TASC II). J. Vasc. Surg. 2007; 45(suppl): S5-67. 6. Shipovskij V.N., Zolkin V.N., Magomedov Sh.G. Ballonnaja angioplastika arterij Goleni [Balloon angioplasty of shin arteries]. Diagnosticheskaja i intervencionnaja radiologija. 2008; 2(4): 55-64 [In Russ]. 7. 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. 8. Sidhu R., Pigott J., Pigott M., Comerota A. Subintimal angioplasty for advanced lower extremity ischemia due to TASC II C and D lesions of the superficial femoral artery. Vasc. Endovascular Surg. 2010 Nov; 44(8): 633-7. 9. Manzi M., Fusaro M., Ceccacci T., et al. Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J. Cardiovasc. Surg. ( 10. Fusaro M., Dalla Paola L., Biondi-Zoccai G. Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia. J. Invasive Cardiol. 2007; 19: E34-37. 11. Ikushima I., Hirai T., Ishii A. et al. Confluent two-balloon technique: an alternative method for subintimal recanalization of peripheral arterial occlusion. J. Vasc. Interv. Radiol. 2011 Aug; 22(8): 1139-43. 12. Montero-Baker M., Schmidt A., Brunlich S. et al. Retrograde approach for complex popliteal and tibioperoneal occlusions. J. Endovasc. Ther. 2008; 15: 594-604. 13. Nicoloff A.D., Taylor L.M. Jr., McLafferty R.B., Moneta G.L., Porter J.M. Patient recovery after infrainguinal bypass grafting for limb salvage. J. Vasc. Surg. 1998; 27: 256-263. 14. Zaheed T., DO. Transcollateral Approach for Percutaneous Revascularization of Complex Superficial Femoral Artery Chronic Total Occlusion. J. invasive cardiol. 2013; 25(5): E96-E100. 15. Zander T., Rabellino M., Baldi S., Blasco O., Maynar M. Infrainguinal revascularization using the Crosser vibrational system. Minim Invas. Ther. Allied Techno. 2010; 19:231-236. 16. Fusaro M., Dalla Paola L., Brigato C. et al. Plantar to dorsalis pedis artery subintimal angioplasty in a patient with critical foot ischemia: a novel technique in the armamentarium of the peripheral interventionist. J. Cardiovasc. Med. 2007; 8: 977-980. 17. Fusaro M., Agostoni P., Biondi-Zoccai G. «Transcollateral» angioplasty for a challenging chronic total occlusion of the tibial vessels: a novel approach to percutaneous revascularization in critical lower limb ischemia. Cathet. Cardiovas. Interv. 2008; 71:268-272. 18. Kaneda H., Takahashi S., Saito S. Successful coronary intervention for chronic total occlusion in an anomalous right coronary artery using the retrograde approach via a collateral vessel. J. Invas. Cardiol. 2007; 19:E1-E4. 19. Chandra S., Chadha D.S., Swamy A. «Transcollateral» renal angioplasty for a completely occluded renal artery. Cardiovasc. Intervent. Radiol. 2011; 34 (suppl 2):S64-S66.
