Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries

Peripheral artery diseases are a worldwide medical and social problem. Approximately 30 % of patients with critical limb ischemia will undergo amputations and 25 % will die after 1 year. These patients require reconstructive and angioplastic interventions to preserve the limb. The aim of the study is to compare the effectiveness of different endovascular surgical technologies in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries. Materials and methods. Among 243 endovascular interventions, 51 patients were presented with multilevel steno-occlusive lesions of the infrarenal aortic arteries as a result of atherosclerosis obliterans. 42 patients (82.4 %) had two-level lesions and 9 (17.6 %) had three-level lesions. Results. Among 42 patients with a two-level lesion, 29 (56.9 %) ones had femoral arterial segment affection in combination with tibial artery affection. 13 (25.5 %) patients suffered from the lesion of the iliac segment in combination with the affection of the femoral segment arteries. In 9 (17.6 %) patients the lesions of three or more levels were determined: an iliac segment in combination with femoral and popliteal arteries – in 4 patients, and in 2 patients there were lesions of the femoral, popliteal and tibial segments, in 3 patients there was a lesion of the iliac, femoral, popliteal and tibial-foot segments in different degrees of severity. 7 balloon angioplasties and 13 stenting procedures were performed in two and three-level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used to revascularize the infraingvinal arterial segments. In the early postoperative period, the complications included thrombosis appeared in 6 patients. It was possible to restore the blood flow and save the limb only in 3 persons. For the other 3 ones, the attempts to restore the patency of the arteries were unsuccessful and resulted in the amputation of the lower extremity. Mortality in the early postoperative period was 3.9 % (2 death due to myocardial infarction). Conclusions. The persons with multilevel steno-obstructive lesions of the infrarenal aortic arteries are the most difficult category of patients with CLI. The surgical method of choice for patients with multilevel steno-occlusive lesions is the endovascular angioplasty with or without stenting.

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The inconsistencies between conventional and global lab tests in cardiosurgeric patient (a clinical case)

Clinical review for general practice ◽

10.47407/kr2020.1.1.00010 ◽

2020 ◽

Vol 1 (1) ◽

pp. 68-70

Author(s):

Eugene Roitman ◽

◽

Keyword(s):

Postoperative Period ◽

Clinical Case ◽

Early Postoperative Period ◽

The Other ◽

Laboratory Methods ◽

Hemostatic System

The clinical case demonstrates inconsistencies between the results of thromboelastography and conventional coagulation lab tests at the early postoperative period of patient undergoing cardiosurgery. The analyzing of the revealed discrepancy proves that the opposition of laboratory methods as 'one against the other' for studying the hemostatic system is unacceptable.

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

Vestnik of Russian military medical Academy ◽

10.17816/brmma12338 ◽

2018 ◽

Vol 20 (4) ◽

pp. 164-168

Author(s):

K N Movchan ◽

V K Suhov ◽

B S Artyushin ◽

E A Shlojdo ◽

V V Shlomin ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Lower Extremities ◽

Limb Ischemia ◽

Vascular Reconstruction ◽

General Information ◽

Early Postoperative Period ◽

Negative Consequences ◽

Surgical Interventions ◽

Endovascular Interventions ◽

Open Reconstruction

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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FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

Клінічна та профілактична медицина ◽

10.31612/2616-4868.4(18).2021.06 ◽

2021 ◽

Vol 4 (18) ◽

pp. 38-44

Author(s):

S.Y. Kostiv ◽

I.K. Venger ◽

B.Y. Maslii ◽

B.P. Selskyi ◽

N.I. Tsiupryk ◽

...

Keyword(s):

Postoperative Period ◽

Lower Extremities ◽

Early Postoperative Period ◽

Arterial Blood Flow ◽

Arterial Segment ◽

Arterial Blood ◽

Tibial Arteries ◽

Group I ◽

Hybrid Revascularization ◽

Stenotic Lesions

The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment. Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction. Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries. Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

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A 5.5 years observational follow-up study of patients with critical limb ischaemia treated efficiently by endovascular approach

Romanian Journal of Cardiology ◽

10.47803/rjc.2020.30.2.236 ◽

2020 ◽

Vol 30 (2) ◽

pp. 236-240

Author(s):

Dan F. Filip ◽

Gabriela Kozma ◽

Calin F. Pop

Keyword(s):

Endovascular Treatment ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Peripheral Artery ◽

Arterial Segment ◽

Final Treatment ◽

Endovascular Approach ◽

The Mean ◽

Peripheral Artery Diseases

Objectives – The aim of this study was to describe our experience with endovascular treatment in critical limb ischaemia and to bring new follow-up data about these patients with initial successfully revascularization. Methods – A retrospective study of 181 patients with critical limb ischaemia, with successful endovascular treatment in our institution was performed. We followed death, reintervention and amputation rates during a mean period of 55.1 ± 8.2 months. Results – The mean age of the patients was 65.2±11.6 years. Of these patients, 66.3% were males, 38.1% diabetics, 51.4% active smokers, 21% with chronic kidney disease, 32.6% with other clinical forms of peripheral artery diseases. The final treatment was stenting in 31.5% of cases and balloon angioplasty alone in the rest of the cases. Treated arteries were in the femoral-popliteal segment – 55.6%, aorto-iliac segment – 31.4% and infrapopliteal segment – 13%. 27.6% of the patients underwent procedures on more than one arterial segment. During follow up 11 deaths occurred (6.1%), 27 patients (14.9%) underwent reinterventions for revascularization (endovascular or surgical) and 31 patients (17.1%) suffered further amputations. Conclusions – Despite a certain rate of death, amputation and reintervention, our results suggest that endovascular approach in critical limb ischaemia can be an effi cient and feasible treatment option if its results are optimal at the time of implementation.

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ЭКСТРАКОРПОРАЛЬНАЯ КОРРЕКЦИЯ В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У БОЛЬНЫХ С ТЯЖЕЛОЙ ОСТРОЙ ИШЕМИЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

World Science ◽

10.31435/rsglobal_ws/31072019/6589 ◽

2019 ◽

Vol 1 (7(47)) ◽

pp. 43-47

Author(s):

О. А. Зарудный ◽

Ю. В. Иванова ◽

Б. В. Гилёв

Keyword(s):

Renal Dysfunction ◽

Postoperative Period ◽

Creatine Phosphokinase ◽

Clinical Presentation ◽

Limb Ischemia ◽

Clinical Results ◽

Early Postoperative Period ◽

Preoperative Level ◽

Total Creatine ◽

Blood Creatinine

The clinical results of the use of Continuous Veno-Venous High Flux Dialysis (CVVHFD) in the early postoperative period in 37 patients with severe lower limb ischemia and an elevated preoperative level of blood creatinine were studied. The dynamics of total creatine phosphokinase, myoglobin, potassium in the early postoperative period was studied. The use of CVVHFD before the manifestation of the classic clinical presentation of renal dysfunction reduces the risk of adverse cardiopulmonary events from 26.1% to 14.3% and decreases the incidence of clinical renal dysfunction from 30.4% to 14.3%.

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INTRAOPERATIVE MITOMYCIN C AND 5 FLUOROURACILAPPLICATION DURING PRIMARY TRABECULECTOMY : A COMPARATIVE STUDY

10.36106/6444126 ◽

2021 ◽

pp. 15-17

Author(s):

Gopal Prasad Singh ◽

Urvashi Singh ◽

Alka Jha

Keyword(s):

Postoperative Complications ◽

Mitomycin C ◽

Postoperative Period ◽

Early Postoperative Period ◽

The Other ◽

Average Period ◽

Medical College ◽

Primary Glaucoma

Aim: To compare the outcome variables of these 2 commonly used anti-metabolites 5-Fluorouracil and Mitomycin-C in trabeculectomy surgeries in primary glaucoma. Material & methods: The present study was conducted on 50 eyes of 39 patients of primary glaucoma who underwent trabeculectomy over a period from January 2019 to August 2020 at Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga.The patients were randomly categorized into 2 groups of 25 each. One group received 5-Fluorouracil in the dose of 50 mg/ml for duration of 4 to 5 minutes intraoperatively. The other group received intraoperative Mitomycin-C in the dose of 0.4 mg/ml applied over duration of 2 to 3 minutes. Result:Maximum complications were seen during early postoperative period in which maximum number were seen with POAG (9 cases) followed by PACG (5 cases). Late postoperative complications were seen in POAG and PACG (2 in each). Conclusion:Long-term complications may only become apparent many years later. Since our study had average period follow up of about 42 weeks, we are not able to comment on the long-term complications following the use of these drugs. In this study both 5-Fluorouracil and Mitomycin-C were found to be equally safe.

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Abstract 11: The Role of Human Osteopontin Isoforms in Post-Ischemic Neovascularization

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.11 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Alicia N Lyle ◽

Courtney M Caroti ◽

Grace Sang Hee Lee ◽

Giji Joseph ◽

Saghar Harirforoosh ◽

...

Keyword(s):

Mrna Level ◽

Limb Ischemia ◽

Volume Density ◽

Peripheral Artery ◽

Limb Perfusion ◽

Isoform Expression ◽

Artery Disease ◽

Peripheral Artery Diseases ◽

And Control

Coronary and peripheral artery diseases lead to ischemia, initiating processes that promote neovascularization to restore blood flow and preserve tissue function. We demonstrated previously that osteopontin (OPN), a matricellular cytokine, is critical to ischemia-induced neovascularization. Unlike rodents, humans express 3 OPN isoforms (a, b, and c); however, the roles of these isoforms in neovascularization and cell migration remain undefined. To assess how human OPN isoforms affect neovascularization, OPN -/- mice underwent hind limb ischemia surgery. At the time of surgery, 1.5x10 6 lentivirus particles expressing human OPNa, OPNb or OPNc were delivered by intramuscular injection. While OPNa improved limb perfusion 30.4%±0.8 in OPN -/- mice, OPNc improved perfusion by 70.9%±6.3 (d14; p<0.001 vs. LVGFP), as measured by laser Doppler perfusion imaging. Importantly, both OPNa and OPNc isoforms significantly rescued neovascularization better than OPNb (n=6, p<0.05). Isoform effects on vascular volume, density, connectivity and diameter were further assessed using Micro-CT angiograms. OPNa and OPNc rescued limb function compared to control and OPNb treated animals (61.1%±8.2; 76.2%±9.7; p<0.05), as assessed by voluntary running wheel use. To verify the differences in neovascularization were due to divergent effects on receptor binding and/or signaling and not variations in isoform expression, we confirmed similar OPN isoform expression levels by ELISA (n=6, p=ns) and immunofluorescence. OPN isoforms a and c both increased macrophage infiltration 2.5 fold, as assessed by mRNA (d7; p<0.05) and histology, leading to increases in vascular smooth muscle cell (VSMC) infiltration (d7; p<0.05). Several pro-arteriogenic factors were also significantly increased at the mRNA level. Finally, we confirmed in vitro that OPNa and OPNc significantly increased VSMC migration compared to OPN b and control (49.8%±3.1; 75.2%±6.3; p<0.05). In conclusion, human OPN isoforms may exhert divergent effects on neovascularization through varried effects on macrophage and VSMC recruitment. Human OPN isoforms may represent potential new therapeutic targets to promote neovascularization and preserve function in patients with peripheral artery disease.

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