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.

Surgical Treatment Of Obliterating Arterosclerosis

In the literature review, according to publications of recent years, the state of surgical treatment of obliterating atherosclerosis does not meet the requirements of the time. Currently, all research is aimed at improving the early diagnosis of the disease and their timely treatment by improving the quality and efficiency of surgical intervention. However, despite a large number of works devoted to diagnosis and prognosis of treatment, there are still many unresolved issues. The accumulated experience indicates the need to standardize the preoperative examination of patients in order to predict the outcome of treatment. One of the important aspects of this problem is the development of modern tactics and approaches to surgical treatment. Along with them, it is necessary to evaluate the results of treatment, analyze the quality and determine the effectiveness of traditional operations in modern angiosurgery. It should be noted that today there are a considerable number of new methods of treating atherosclerosis obliterans for early and effective diagnosis, prevention and therapy of the disease. However, some issues are insufficiently studied or contradictory and require further research.

Outcomes of cardiovascular surgery for chronic dialysis patients in current Japan

Background The number of dialysis patients in Japan is rising, with an increasing number requiring cardiovascular surgery. Methods We investigated the short- and long-term outcomes in 70 dialysis patients among a total of 1124 who underwent cardiovascular surgery in our hospital between 2004 and 2016. We investigated outcomes following open surgery and identified factors that affected the prognosis. We also compared the long-term survival rate with the survival rate of the Japanese dialysis population. Results The long-term survival rate was 70.6%, 51.1%, and 19.2% after 3, 5, and 10 years, respectively. The causes of long-term death were heart disease in 8 patients, cerebrovascular disease in 7, cachexia in 3, infection in 2, and other causes in 3. The freedom from cardiac death was 88.7%, 77.9%, and 54.9% after 3, 5, and 10 years, respectively. Multivariate analysis using Cox’s proportional hazard model showed that a history of atherosclerosis obliterans (hazard ratio 5.4, p = 0.05) and mediastinitis (hazard ratio 10.2, p = 0.03) were risk factors for death in long-term follow-up, and a history of atherosclerosis obliterans was an independent risk factor for cardiac death in long-term follow-up (hazard ratio 5.3, p = 0.01). Five-year survival of the study subjects was comparable to that of the Japanese dialysis population. Conclusions The prognosis for dialysis patients after open surgery was equivalent to that of Japanese dialysis patients in general. A high proportion of late postoperative deaths were due to heart disease. Patients with atherosclerosis obliterans had a poor prognosis.