Principles of infragenicular vascular reconstruction in patients with critical limb ischemia

General information about the activity of specialists of the regional vascular centers of St. Petersburg in 2011-2015 is presented. and on the private results of the work of the staff of the center of one of the city’s multidisciplinary hospitals with an assessment of the data on the cases of treatment of 403 patients with critical limb ischemia against the background of arterial lesions of atherosclerosis. Four groups of patients were identified: 278 patients who underwent open reconstruction of the arteries of the lower extremities; 51, who underwent endovascular revascularization; 15, who underwent hybrid surgical interventions. Revascularization was not performed in 55 patients. Among the open operations, loop endarterectomy from the aortoiliac and femoral-popliteal segments (190) and shunting arterial reconstructions (45) prevailed. In endovascular interventions, femoral-popliteal-tibial segments were predominantly corrected - 37 cases. Hybrid operations in 100% of cases are performed through accesses through the femoral arteries. In case of refusal of reconstruction due to the absence of an anatomic substrate for the reconstruction of the vessels, primary amputation of the lower limb (15), lumbar sympathectomy (14) were performed. In 30 cases, angiotropic therapy was performed. Complications of open surgical interventions in the early postoperative period were revealed in 21,6%, endovascular - in 15% of cases, hybrid operations were noted in 13,3% (in total91 complications in 70 patients). Thrombosis of the vascular reconstruction area (35%) and inadequacy of perfusion of limb tissues in permeable vessels (19,7%) prevailed in the structure of complications. There were no lethal outcomes. In general, the use of endovascular and hybrid reconstructions of the vascular bed in specialized divisions of medical organizations in patients with critical limb ischemia with multifocal atherosclerosis contributes to a significant reduction in the frequency of negative consequences of surgical revascularization of the lower extremities.

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Risk assessment of vascular reconstruction by patients with critical limb ischemia and aortoiliac occlusive disease

Cardiovascular Surgery News ◽

10.24022/2588-0284-2019-3-2-87-93 ◽

2019 ◽

Vol 3 (2) ◽

pp. 87-93

Author(s):

A.N. Vachev ◽

A.V. Krugomov

Keyword(s):

Risk Assessment ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vascular Reconstruction ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease

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Therapeutische Alternativen in der Behandlung schwerer Beinischämien: Erfahrungen bei 190 Patienten an einer Klinischen Abteilung für Angiologie

VASA ◽

10.1024/0301-1526.28.4.271 ◽

1999 ◽

Vol 28 (4) ◽

pp. 271-278 ◽

Cited By ~ 4

Author(s):

Gschwandtner ◽

Minar ◽

Ahmadi ◽

Haumer ◽

Hülsmann ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Vascular Reconstruction ◽

Transluminal Angioplasty ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Chronic Critical Limb Ischemia ◽

Short And Long Term

Background: Different therapies in consecutive patients (1987–1992) with chronic critical limb ischemia at a department of medical angiology, their short- and long-term outcome were investigated. Patients and methods: 190 patients (112 males, 78 females; age: 67 ± 12 years); 78 in grade II, 112 in grade III according to Rutherford’s classification. Therapeutic regimen: 1. vascular recanalisation by percutaneous transluminal angioplasty [PTA], local or systemic lysis; 2. surgical vascular reconstruction in case of impossibility or failure of catheter procedures; 3. prostanoids and/or antibiotics; 4. local wound treatment including amputations. Results: Vascular recanalisation was attempted in 156/190 (82.1%): PTA in 116/190, surgical vascular reconstruction in 50/190, local in 24/190 and systemic lysis in 8/190 patients. Prostanoids were applied in 89/190 and antibiotics in 73/190 patients. At the time of dismissal 164/190 (86.3%) patients were clinically improved; 11/190 (5.8%) unchanged, 13/190 (6.8%) had undergone major amputations and 2/190 (1.1%) had died. After 2,6 ± 2,2 years 77 of the 141 patients, who were still alive, were reexamined. Among these 77 patients 84.4% were in grade 0 or I, 15.6% in chronic critical limb ischemia. Furthermore 13.0% had been amputated since dismissal. Forty-nine of 190 (25.8%) patients had died 3,2 ± 1,9 years after dismissal from hospital. Conclusion: Catheter techniques, mostly PTA, is possible in the majority of patients with chronic critical limb ischemia. Cooperation with vascular surgeons in case of technical impossibility or failure of catheter recanalisation is mandatory. Such a regimen yields satisfactory short- and long-term results and a low rate of complications.

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