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.

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Abstract:

Case report is devoted to atypical recanalization of chronic occlusions of the common iliac artery Today, there are several ways for recanalization of chronic occlusions of arteries of lower limbs. Recanalization is known to be the major point of endovascular procedures. The success of endovascular surgery at recanalization depends mainly on 2 factors. One of the most important factors is the choice of access. Another factor is the choise of recanalization method . In case of rare failures - performing open surgery.

Refrrences 

1.    Pokrovsky A.V. and other. Russian consensus. Recommended standards for the evaluation of patients with chronic lower limb ischemia. M. 2001; 16 [In Russ].

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Abstract:

A literature review is devoted to endovascular treatment of occlusive and stenotic lesions in arteries of femoral-popliteal segment.

Currently, 2-3% of the RF population suffer from atherosclerotic lesions of arteries of lower limbs. In the structure of cardiovascular disease, atherosclerosis of lower limbs has the level about 20%. In 82% the cause of vascular disease is atherosclerosis. In the structure of atherosclerotic arterial disease of lower limbs more often (47% to 65%) occurs defeat of the femoral-popliteal segment particularly in patients older than 60 years; that is confirmed by numerous statistical observations. The aim of the article was to compare results of endovascular treatment of arterial lesions of the femoral-popliteal segment.

This article presents results of a solo balloon angioplasty, balloon angioplasty with drug-eluting balloons, subintimal angioplasty, stenting drug-eluting and bare-metal stents, cryo-plastics,catheter atherectomy, hybrid interventions and compare results of open and endovascular interventions. Data of STAR register, published in 2001, show that the correction of lesions category C, TASC II, using balloon angioplasty is quite possible to count on similar results in category B.

According to Conrad M. et.al, Amato B. et.al and Dey C., despite the high incidence of the primary success of endovascular interventions for femoral-popliteal segment long-term results often look depressing.

Great importance is given to study the possibility of the use of drug-eluting stents, which have proven effectiveness in suppressing the inflammatory response and intimal hyperplasia after stenting of coronary arteries, as evidenced by research SIROCCO, SIROCCO II, STRIDES, Zilver PTX. Thus, the use of drug-eluting stents in the femoral-popliteal segment did not reduce the frequency of restenosis.

THUNDER, FemPac and LEVANT researches indicate that drug-eluting balloons provide some benefits that are absent in other endovascular techniques such as solo balloon angioplasty and stenting.

The final stage of a multicenter randomized trial BASIL, which carried out a comparative analysis of FPB and PTA groups, was reached in 2010. As a result, the preservation of limbs and survival did not differ significantly

Thus, the literature report reveals a clear tendency of domination of endovascular strategies in defeated limb blood-flow recovery Minimally invasive balloon angioplasty and stenting compared with results of bypass operations, reconstructions - is not worse and consider endovascular treatment strategy in the surgical treatment of femoral-popliteal segment to be method of first choice. 

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Abstract:

Article describes results of single-balloon angioplasty and stenting in patients with occlusive-stenotic lesions of femoral-popliteal segment for the period of 30 months. It was performed 209 endovascular interventions, single-balloon angioplasty in 95 patients; stenting - 114 patients. Long-term results of primary patency: 43,1% in group of single-balloon angioplasty 57,1% - in group with stenting.

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