Auto-venous femoral-popliteal bypass in patients with critical lower extremity ischemia and coronary heart disease associated with diabetes melitus

Аim — to improve the results of treatment of patients with atherosclerotic lesions of the arteries of femoral-popliteal segment, who underwent autovenous femoral-popliteal bypassgrafting.Materials and methods. During the period of years 2018 to 2021, 34 patients with critical ischemia of the lower extremities underwent autovenous shunting with a reversed great saphenous vein with treatment of the inner surface of the vein with a solution of cytostatics (paclitaxel). Besides, the treatment was analysed in two control groups, who underwent autovenous reverse vein shunting (30 patients) and autovenous in-situ shunting (33 patients). The follow-up periods lasted for 24 months. The evaluation criteria included the cases of shunt thrombosis, shunt stenosis, mortality, serious ischemic events — acute lower extremity ischemia, myocardial infarction, ischemic stroke, cases of high amputations of the lower extremities.Results. In the postoperative period, no deaths were observed; absence of complicationswas registered in 96 (98 %) patients. In the main group, the frequency of shunt thrombosis was 5 (14.7 %), hemodynamically significant restenosis was diagnosed in 6 patients (17.6 %), acute myocardial infarction in 1 patient (2.9 %). In the comparison group, 11 cases of autovenous shunt thrombosis were defined.Conclusions. Our clinical experience showed promising short- and medium-term results. The chosen surgical approach and topical application of cytostatic drugs enabled to achieve long-term patency of venous shunt, which is of particular importance for patients with diabetes mellitus.

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Arterial Imaging in Patients with Lower-extremity Ischemia and Diabetes Mellitus

Journal of the American Podiatric Medical Association ◽

10.7547/1000412 ◽

2010 ◽

Vol 100 (5) ◽

pp. 412-423 ◽

Cited By ~ 1

Author(s):

Frank Pomposelli

Keyword(s):

Diabetes Mellitus ◽

Lower Extremity ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Patients With Diabetes ◽

Ischemic Complications ◽

Lower Extremity Ischemia ◽

Tomographic Angiography ◽

Extremity Ischemia ◽

Arterial Imaging

Precise comprehensive imaging of arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental, with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified, and patients with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography, contrast-enhanced magnetic resonance angiography, and, more recently, computed tomographic angiography have been used as imaging modalities in lower-extremity ischemia. Each modality has specific advantages and shortcomings in this patient population, which are summarized and contrasted in this review. (J Am Podiatr Med Assoc 100(5): 412–423, 2010)

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Ascending and Aortic Arch Thrombus: Cause of Myocardial Infarction and Lower Extremity Ischemia

Journal of Medical Cases ◽

10.14740/jmc2074w ◽

2015 ◽

Vol 6 (4) ◽

pp. 156-158 ◽

Cited By ~ 1

Author(s):

Nneoma Olivia Okoronkwo ◽

Frank Wang ◽

Gabriele Di Luozzo

Keyword(s):

Myocardial Infarction ◽

Lower Extremity ◽

Aortic Arch ◽

Lower Extremity Ischemia ◽

Extremity Ischemia

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Treatment of patients with occlusive-stenotic diseases of the arteries by endovascular method

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(3)-12 ◽

2021 ◽

Vol 25 (3) ◽

pp. 419-423

Author(s):

V. V. Shaprynskyi

Keyword(s):

Mortality Rate ◽

Lower Extremity ◽

Postoperative Period ◽

Early Postoperative Period ◽

Limb Amputation ◽

Results Of Treatment ◽

Lower Extremity Ischemia ◽

The Right ◽

Angioplasty And Stenting ◽

Extremity Ischemia

Annotation. The case of successful treatment of a patient with critical lower extremity ischemia illuminates the possibilities of different approaches of the endovascular surgical method. The results of treatment of patients with occlusive-stenotic diseases of the lower extremities arteries as a result of obliterating atherosclerosis were analyzed. 243 patients underwent endovascular surgery. 14 (5.76%) patients were previously operated on. The multi-storey lesions were found in 35 (14.4%) cases. Most patients were ranged in age from 46 to 86 years. There were 175 men (72.0%) and 68 women (28.0%). The right lower extremity was affected more often – 148 (60.9%) patients than the left ones – 95 (39.1%). The thrombosis was diagnosed in 21 (10.6%) individuals as the most common complications in the early postoperative period. Limb amputation was performed in 12 patients. Mortality rate in the early postoperative period was 2.56% (4 patients died). It is established that the methods of choice in the reconstruction of stenotic-occlusive lesions of the arteries are: balloon angioplasty (and stenting), rotor-mechanical thromboaspiration, regional thrombolytic therapy. These methods are performed mainly under local anesthesia, they are minimally invasive and can be used in patients with severe comorbidities.

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