Possibilities of using endovascular methods of treatment of patients with critical limb ischemia in regional vascular centers

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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Contemporary Trends in Hospital Admissions and Outcomes in Patients With Critical Limb Ischemia

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.007539 ◽

2021 ◽

Vol 14 (2) ◽

Author(s):

Mahesh Anantha-Narayanan ◽

Rajkumar P. Doshi ◽

Krunalkumar Patel ◽

Azfar Bilal Sheikh ◽

Fiorella Llanos-Chea ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Critical Limb Ischemia ◽

Hospital Admissions ◽

Limb Ischemia ◽

International Classification Of Diseases ◽

Surgical Interventions ◽

Hospital Size ◽

Black Race ◽

Endovascular Interventions

Background: Critical limb ischemia (CLI) morbidity and mortality rates have historically been disproportionately higher than for other atherosclerotic diseases, however, recent trends have not been reported. In patients admitted with CLI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of hospitalizations overall and stratified by type of revascularization procedures. Methods: Using 2011 to 2017 National Inpatient Sample data, we identified CLI-related admissions based on International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification codes. Primary outcomes of interest were in-hospital mortality and major amputations. Secondary outcomes were the length of stay and cost of hospitalization. We stratified outcomes based on endovascular or open surgical interventions. We also performed hierarchical multivariable regression analyses of outcomes based on age, sex, race, hospital size, type, and location. Results: We identified 2 643 087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4% P trend <0.0001 as well as overall peripheral artery disease admissions (4.5%–8.9%, P trend <0.0001). In-hospital mortality for the entire CLI cohort decreased from 3.3% to 2.7%, P trend <0.0001, and major amputations decreased from 10.9% to 7%, P trend <0.0001. A decline was also noted for the length of stay from 5.7 (3.1–10.1) to 5.4 (3.0–9.2) days ( P trend <0.0001), whereas admission costs increased from USD $11 791 ($6676–$21 712) to $12 597 ($7248–$22 748; P trend <0.0001). Endovascular interventions increased ( P trend <0.0001) against a decline in surgical interventions ( P trend <0.0001). Black race, female sex, and age ≥60 years were associated with higher in-hospital mortality, whereas Black race, male sex, and age<60 years were associated with higher major amputations. Conclusions: A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLI admissions over recent years. Patients with CLI received more endovascular interventions than surgical interventions over time. However, admissions for endovascular interventions were characterized by higher risk patient profiles and a higher risk of major amputations as compared with surgical interventions.

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NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

Journal of the Grodno State Medical University ◽

10.25298/2221-8785-2020-18-6-710-715 ◽

2020 ◽

Vol 18 (6) ◽

pp. 710-715

Author(s):

N. N. Ioskevich ◽

◽

L. F. Vasilchuk ◽

P. E. Vankovich ◽

S. P. Antonenko ◽

...

Keyword(s):

Lower Limb ◽

Type I Diabetes ◽

Lower Extremities ◽

Limb Ischemia ◽

Type I ◽

Critical Ischemia ◽

Lower Limb Ischemia ◽

X Ray ◽

Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

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Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

The American Surgeon ◽

10.1177/000313480507100605 ◽

2005 ◽

Vol 71 (6) ◽

pp. 474-480 ◽

Cited By ~ 10

Author(s):

Susan M. Trocciola ◽

Rabih Chaer ◽

Rajeev Dayal ◽

Stephanie C. Lin ◽

Naveen Kumar ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Clinical Success ◽

Ankle Brachial Index ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Arterial Disease ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

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Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia

International Angiology ◽

10.23736/s0392-9590.17.03809-3 ◽

2017 ◽

Vol 36 (5) ◽

Author(s):

Nicola Troisi ◽

Filippo Turini ◽

Emiliano Chisci ◽

Leonardo Ercolini ◽

Pierfrancesco Frosini ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Limb Ischemia ◽

Diabetic Patients ◽

Endovascular Interventions

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Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

Vascular Medicine ◽

10.1177/1358863x16676901 ◽

2016 ◽

Vol 22 (1) ◽

pp. 28-34 ◽

Cited By ~ 10

Author(s):

Caitlin W Hicks ◽

Alireza Najafian ◽

Alik Farber ◽

Matthew T Menard ◽

Mahmoud B Malas ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Multivariable Analysis ◽

Limb Ischemia ◽

Major Amputation ◽

Primary Patency ◽

Tissue Loss ◽

Vascular Intervention ◽

Below The Knee ◽

Endovascular Interventions ◽

One Year

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

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Determination of the Need for Reconstructive Surgical Interventions Using Conduits of Biological Origin in Acute Arterial Insufficiency

Kardiologiia vid nauky do praktyky ◽

10.30702/card:sp.2020.10.039/0392740 ◽

2020 ◽

pp. 27-40

Author(s):

A Lyzikov ◽

M Kaplan ◽

V Tsikhmanovich ◽

V Straltsov ◽

S Gorokhovsky

Keyword(s):

Plastic Material ◽

Lower Extremities ◽

Limb Ischemia ◽

Biological Origin ◽

Contralateral Limb ◽

Surgical Interventions ◽

Atherosclerotic Lesions ◽

Plastic Materials ◽

Reconstructive Operations ◽

Arterial Insufficiency

The aim of the study was to determine the structure of the pathology that causes acute arterial insufficiency, which requires the implementation of surgical interventions, including reconstructive operations using conduits of various origins; to identify the needs for grafts of biological origin. Material and methods. A retrospective analysis of 212 case histories of patients with acute arterial insufficiency of the lower extremities who underwent open surgery on the arteries of the lower extremities at the department of vascular surgery of the Gomel Regional Clinical Cardiology Center from 2017 to 2019 was performed. Results and discussion. As a result of the study, the following issues were identified. Surgical treatment of acute arterial insufficiency, which developed due to thrombosis with the progression of atherosclerotic lesions, requires reconstructive surgery using various plastic materials as patches and conduits in 60% of the total number of open operations. There is a serious need for materials of biological origin as a plastic material for the treatment of acute arterial insufficiency, which developed against the background of atherosclerotic vascular damage, because 59% of the total number of primary operations were bypass surgeries, of which, in 73.7% of cases, for various reasons, synthetic transplants were used. The high frequency of repeated surgical interventions, reaching 28.9% of the total number of operations, more often on injured limbs in 97% of patients, including those after application of autological venous conduits in 40.7% of cases, is a serious problem that needs to be solved by searching for new sources for biological materials. Atherosclerotic damage to the contralateral limb occurred in 53.2% of patients with thrombosis and in 17.8% with embolism, while in 62.6% of patients with thrombosis, the degree of chronic arterial insufficiency in the contralateral limb was greater than 2 (Fontaine’s classification of chronic limb ischemia), which is indicative for reconstructive surgical interventions.

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