Treatment of critical limb ischemia in patients with multilevel arterial lesions


  • V. Shaprynskyi
  • Y. Gupalo
  • O. Shved
  • O. Nabolotnyi
  • D. Shapovalov
Keywords: critical ischemia of the lower extremities, hybrid surgery, endovascular surgery, multilevel arterial lesion

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.

References

1. Litvinova, N. Yu., Mishalova, A. V. & Zavodovskyi, Ye. V. (2011). Rekomendatsii Yevropeiskoho tovarystva kardiolohiv z diahnostyky ta likuvannia zakhvoriuvan peryferychnykh arterii [Recommendations of the European Society of Cardiologists for Diagnosis and Treatment of Peripheral Artery Diseases]. Chastyna I. Sertse i sudyny – Hart & Vessels, 4, 19–35.

2. Mishalov, V. G. & Chernyak, V. A. (2010). Lechenie kriticheskoj ishemii nizhnih konechnostej u bolnyh s sochetannymi mnogoetazhnymi porazheniyami aorty i ee vetvej [Treatment of critical lower limb ischemia in patients with combined high-rise lesions of the aorta and its branches]. Vestnik neotlozhnoj i vosstanovitelnoj mediciny – Bulletin of Urgent and Recovery Medicine, 3, 377–9.

3. Nikulnikov, P. I., Byshaj, A. N., Ratushnyuk, A. V. & Liksunov, A. V. (2013). Osobennosti hirurgicheskoj taktiki pri mnogourovnevyh okklyuzionno-stenoticheskih porazheniyah bedrenno-bercovogo arterialnyh segmentov [Features of surgical tactics in multilevel occlusive-stenotic lesions of the femoral-abortive arterial segments]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 3 (60), 148–51.

4. Pityk A. I. (2015). Alternativnye podhody k endovaskulyarnoj revaskulyarizacii nizhnih konechnostej u bolnyh s kriticheskoj ishemiej [Alternative approaches to endovascular revascularization of lower limbs of patients with critical ischemia]. ISSN 1727-5717. Sertse i sudyny – Hart & Vessels, 1, 70–76.

5. Catalano, M. (1993). Epidemiology of critical limb ischaemia: North Italian data. Eur. J. Med., 2 (1), 11–14. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8257998.

6. Gandini R., Uccioli L., Spinelli, A., Del Giudice, C., Da Ros, V., Volpi, T. & Simonetti, G. (2013). Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia. Cardiovasc Intervent Radiol., 36 (1), 75–83. doi: 10.1007/s00270-012-0344-x.

7. Jens, S., Conijn, A. P., Koelemay, M. J., Bipat, S. & Reekers, J. A. (2014). Randomized trials for endovascular treatment of infrainguinal arterial disease: systematic review and meta-analysis (Part 2: Below the knee). Eur. J. Vasc. Endovasc. Surg., 47 (5), 536–44. doi: 10.1016/j.ejvs.2014.02.012.

8. Kanne, W. B. (1994). Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J. Cardiovasc. Risk., 1 (4), 333-9. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7621317.

9. Kroger, K., Stang, A., Kondratieva J., Moebus S, Beck E, Schmermund A … Erbel R. (2006). Prevalence of peripheral arterial disease results of the Heinz Nixdorf recall study. Eur. J. Epidemiol., 21, 279–85. DOI:10.1007/s10654-006-0015-9.

10. Norgren, L., Hiatt, W. R., Dormandy, J. A., Nehler, M. R., Harris, K. A. & Fowkes, F. G. R. (2007). Intersociety consensus for the management of peripheral arterial disease (TASC II). Eur. J. Vasc. Endovasc. Surg., 33, S5-S75. DOI: https://doi.org/10.1016/j.jvs.2006.12.037.

11. Ruiter, M. S., van Golde, J. M., Schaper, N. C., Stehouwer, C. D. & Huijberts, M. S. (2010). Diabetes impairs arteriogenesis in the peripheral circulation: review of molecular mechanisms. Clin. Sci. (Lond)., 119 (6), 225–38. doi: 10.1042/CS20100082.

12. Santos V. P., Alves, C., Fidelis, C. & Araújo Filho, J. S. (2013). Arteriographic findings in diabetic and nondiabetic patients with critical limb ischemia. Rev. Assoc. Med. Bras., 59 (6), 557–62. doi: 10.1016/j.ramb.2013.06.009.

13. Setacci, C., Sirignano, P., Galzerano, G., Mazzitelli, G., Sauro, L., de Donato, G., … Setacci, F. (2013). Endovascular first as “preliminary approach” for critical limb ischemia and diabetic foot. J. Cardiovasc Surg (Torino), 54 (6), 679–84. https://www.ncbi.nlm.nih.gov/pubmed/24126506.

14. Sobel, M. & Verhaeghe, R. (2008). Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence Based Clinical Practice Guidelines (8th Edition). Chest., 133 (6), 815S-843S. doi: 10.1378/chest.08-0686.
Published
2018-09-28
How to Cite
Shaprynskyi, V., Gupalo, Y., Shved, O., Nabolotnyi, O., & Shapovalov, D. (2018). Treatment of critical limb ischemia in patients with multilevel arterial lesions. Reports of Vinnytsia National Medical University, 22(3), 474-478. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2018-22(3)-16