Improvement of surgical treatment of patients with critical ischemia of the lower extremities
Keywords:Critical limb ischemia, Multifocal atherosclerosis, Staged intervention
Background: The choice of tactics of surgical treatment in patients with lesions of the femoral-popliteal-tibial segment with the CILE is the actual problem, which is far from being solved. Aim of the study was to found improved treatment of patients with critical ischemia of the lower extremities by improving the surgical approach.
Methods: 79 patients with critical ischemia of the lower extremities with lesions of the carotid and coronary arteries were observed and surveyed. To determine the tactics of treatment of these patients, we used non-invasive methods of imaging vessels, and only with probable therapeutic purposes used the contrasting of the vessels.
Results: The used treatment allowed reducing the number of complications to a minimum. Among observable patients, in one case was determined acute myocardial infarction. 19 (24%) patients with stenosis and CILE managed to achieve regress of clinical manifestations of lower limb ischemia with medical therapy. In 12 (63.1%) patients were completed the installation of long catheter for intra-arterial catheter therapy, after that we performed carotid endarterectomy. Of these, 9 (47.3%) patients at 7 days underwent reconstructive operations on arteries of the lower extremities. In 5 (26.3%) patients after carotid endarterectomy, endovascular interventions implemented at ALE.
Conclusions: The suggested diagnostic low and stages of surgical interventions significantly increase the detection of associated lesions of other arterial basins and expands the indications for surgical treatment with the use of combined interventions.
Babunashvili MA, Glagolev VE, Kartashov DS. Multi-stage endovascular treatment of multifocal atherosclerosis. Journal Archive. 2013;53(11):90-5.
Bebeshko VG. To optimize the diagnosis of early manifestations of thrombotic complications in patients with atherosclerotic lesions of the main vessels of the lower extremities. Sci J Ministry Health Ukraine. 2014;1(5):78-84.
Kuranov AA, Baleev MS, Mitrofanova NN. Some aspects of the pathogenesis of atherosclerosis and the risk factors of cardiovascular diseases. Fundament Res. 2014;10:1234-8.
Murav'eva IY. Tactical mistakes in the treatment of patients with critical ischemia during a reconstruction of the artery occlusive disease below the cords. Avtoref Dis Candidate Med Sciences. 2014;25:11.
Oganov RG. Cardiovascular comorbidity: common approaches to prevention and treatment rational pharmacotherapy in cardiology. 2015;11(1):4-7.
Pocheptsova EG. Atherosclerosis of lower limb arteries and coronary artery disease. Pharmacotherapy. 2014;9(185):62-68.
Conte MS, Pomposelli FB, Clair DG. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Cardiovasc Surg. 2015;61(5):1382-4.
Gavrilova NE, Metelskaya VA, Yarovaya EB, Boytsov SA. The role of duplex scanning of the carotid arteries to identify coronary atherosclerosis and determining the degree of its severity. Rus J Cardiol. 2014;4(108):108-12.
Gozhenko AI, Kovalevskaya LA, Kotyuzhinskaya SG. Atherosclerosis: new achievements and failures. J Health Sci. 2014;04(04):101-14.
Gulati A, Botnaru I, Garcia LA. Critical limb ischemia and its treatments: a review. J Cardiovasc Surg. 2015;56(5):775-85.
Ivanov LN. A new diagnostic technique of multifocal atherosclerosis. СТМ. 2013;5(2):53.
Lambert MA. The treatment of critical ischemia of lower limbs: where do we stand today? J Int Med. 2013;274:295-307.
Rumyantsev SA, Oganov RG, Silina EV. Cardiovascular pathology in acute stroke (some aspects of the prevalence, prevention, and therapy). Cardiovascular therapy and prevention. 2014;13(4):47-53.
Rumjantseva SA, Stupin VA, Oganov RG. Theory and practice of treatment of patients with vascular comorbidity. Clinical Guideline. Moscow-Spb. International Publishing Group. Medical Book; 2013:243-51.