Comparative results of different methods of arterial reconstruction in the patients with critical stenosis of the femoral-popliteal-tibial segment

Abstract

Introduction. Critical limb ischemia (CLI), which arises from atherosclerotic lesions of the arteries is quite often presently. This problem is actively discussed all over the world. In addition to the disability of the patients due to limb loss, the death rate from this disease is comparable to mortality from malignant tumors. Objective. Evaluate immediate and long-term results and optimize treatment tactics for patients with critical limb ischemia in multilevel lesions of lower limb arteries. Materials and methods. The examination and treatment of patients with CLI was carried out in the Research Institute of Surgery and Urgent Medicine of the First State Medical University of Saint-Petersburg named by I. P. Pavlov, as well as on the basis of the City Clinical Hospital «City Hospital No. 14» and St. Petersburg Research Institute of Emergency Care named by I. I. Dzhanelidze in the period from 2005 to 2016. The study is conducted in patients with atherosclerotic lesion of the main arteries of the lower extremities, which manifests itself as pain at rest and/or tissue loss (stage 3-4 of chronic arterial insufficiency of the limb according to Fontein-Pokrovsky classification). Results. Clinical success of all kinds of interventions was achieved in 166 (88.8 %) patients. However, the negative results were greater in the group where only angioplasty of the lower limb arteries was performed. Long-term results could be traced in 108 (57.8 %) patients for 6 months - 5 years. If we consider all groups as a whole, then the aggravation of ischemia occurred in endovascular intervention group in 62 % of patients, in the group of bypass operations - in 19.61 %, and in the group of hybrid interventions - in 17.65 %. Conclusion. Hybrid methods of treatment are the method of choice for patients with stage 4 ischemia of the lower limb with multilevel lesions of lower extremity arteries. Open surgery on the arteries of the lower extremities remains a very effective method of treating patients with critical ischemia. In turn, the use of endovascular methods is advisable in patients with severe concomitant pathology.

Results of Using Endovascular Technologies for Removal of Critical Lower Limb Ischemia in Patients of Regional Vascular Centres Located at Multidisciplinary Hospitals

“…One such way is to create new and improve the existing regional vascular centers [2]. Atherosclerotic changes in lower-limb arteries cause most of the critical ischemia cases [3]. Atherosclerosis is usually associated with multifocal and multilevel damage to the vascular bed [4].…”

“…Preoperative AG helps not only find the extent, to which the lower-limb arterial bed has been affected, or plan the surgery, but also monitor the intraoperative and postoperative outcomes [6]. These technologies are important for endovascular or hybrid surgery of general vascular pathologies, in particular, those complicated by critical lower-limb ischemia [3]. However, research data on the use of angiography in such cases remains ambiguous.…”