Treatment of critical limb ischemia in patients with multilevel arterial lesions

Abstract

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

Complications associated with the treatment of chronic limb-threatening ischemia

“…According to the 2D European Consensus, the criterion for diagnosing CLTI is the presence of pain at rest with a systolic pressure in the distal third of the lower leg of less than 50 mmHg and/or the presence of a toe systolic pressure of less than 30 mmHg, or with trophic changes in the soft tissues of the foot or toes with the same indicators of systolic blood pressure [2,3]. Atherosclerotic lesions of the lower limb arteries in more than 97 % of cases are the cause of the CLTI development [4,5]. Other causes of development include diabetic foot syndrome, peripheral thrombosis and embolism in atrial fibrillation, mitral valve defects, aneurysms of the aorta and iliac arteries, the consequences of mechanical trauma to the arteries, obliterating endarteritis, nonspecific aortoarteritis (Takayasu's disease), obliterating thromboangiitis (Buerger's disease) [6].…”