Metabolic disorder and outcomes of reconstructive interventions in patients with peripheral arterial disease

Abstract

The purpose of this study was to assess the effect of metabolic disorders on the effects of revascularization in patients with obliterating atherosclerosis.

Materials and methods. The reconstruction was performed in 253 patients with femoral-tibial arterial segment lesion (98 — open operations, 116 — endovascular interventions and 39 patients were treated with hybrid technique).

Results. Endovascular revascularization techniques are justified in case of disorders of carbohydrate metabolism. Conventional operations remain the method of choice in the case of those variants of atherosclerotic lesions, where minimally invasive techniques are impossible.

Conclusions. Metabolic disorders in patients with peripheral atherosclerosis on the background of severe comorbid pathology may be the basis for choosing hybrid methods of revascularization.

Keywords

metabolic disorders / reconstructive vascular interventions / hybrid methods

References

[1] Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation. 2004;110(6):738-743. https://doi.org/10.1161/01.CIR.0000137913.26087.F0.

[2] Hirsch AT, Haskal ZJ, Hertzer NR, et al.; American Association for Vascular Surgery, Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):e463-654. https://doi.org/10.1161/CIRCULATIONAHA.106.174526.

[3] Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-1934. https://doi.org/10.1016/S0140-6736(05)67704-5.

[4] Belch JJ, Topol EJ, Agnelli G, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884-892. https://doi.org/10.1001/archinte.163.8.884.

[5] Chi YW, Jaff MR. Optimal risk factor modification and medical management of the patient with peripheral arterial disease. Catheter Cardiovasc Interv. 2008;71(4):475-489. https://doi.org/10.1002/ccd.21401.

[6] Глушков Н.И., Иванов М.А., Артемова А.С. Итоги различных методов реваскуляризации у пациентов с критической ишемией нижних конечностей на фоне периферического атеросклероза // Кардиология и сердечно-сосудистая хирургия. − 2017. − Т. 10. − № 3. − С. 50−56. [Glushkov NI, Ivanov MA, Artemova AS. Results of various revascularization methods in patients with critical ischemia of lower limbs due to peripheral atherosclerosis. Cardiology & cardiovascular surgery. 2017;10(3):50-56. (In Russ.)]. https://doi.org/10.17116/kardio201710350-56.

[7] Hanna GP, Fujise K, Kjellgren O, et al. Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry. J Am Coll Cardiol. 1997;30(3):664-669. https://doi.org/10.1016/s0735-1097(97)00216-7.

[8] Wiechmann BN Tibial intervention for critical limb ischemia. Semin Intervent Radiol. 2009;26(4):315-323. https://doi.org/10.1055/s-0029-1242205.

[9] Глушков Н.И., Иванов М.А., Артемова А.С., и др. Инфекция в сосудистой хирургии и метаболический синдром: совпадение или взаимосвязь? // Кардиология и сердечно-сосудистая хирургия. − 2017. − Т. 10. − № 1. − С. 56−61. [Glushkov NI, Ivanov MA, Artemova AS, et al. The infection in vascular surgery and metabolic syndrome: a coincidence or correlation? Cardiology & cardiovascular surgery. 2017;10(1):56-61. (In Russ.)]. https://doi.org/10.17116/kardio201710156-61.

[10] Nakanishi N, Takatorige T, Fukuda H, et al. Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men. Diabetes Res Clin Pract. 2004;64(1):59-70. https://doi.org/10.1016/j.diabres.2003.10.001.

RIGHTS & PERMISSIONS

Glushkov N.I., Ivanov M.A., Puzdryak P.D., Samko K.V., Isakova A.A., Artemova A.S.