Revascularization method for patients with infrainguinal arterial disease

Abstract

Aim: The aim of the study was to perform a comparative evaluation of the use of various methods of reconstructive assistance in the repair of the femoral-tibial segment in patients with peripheral arterial disease.

Methods: Two hundred and fifty-three patients with atherosclerotic lesions of arteries below the inguinal ligament were examined and revascularized. According to the type of reconstruction performed, the patients were divided into 3 groups: 98 patients underwent open operative interventions; 116 patients underwent endovascular interventions; 39 had hybrid reconstructions performed.

Results: Minor blood loss, and stability of hemodynamics in the perioperative context positively characterize hybrid effects. The time spent in the resuscitation department and the shorter hospitalization of patients after hybrid revascularization methods were revealed in comparison with open methods. The absence of dangerous complications and the primary patency of the operated segment in the early postoperative period, approaching 100%, characterize hybrid techniques as an effective method of treating patients with infrainguinal arterial disease.

Conclusion: Hybrid technologies are characterized by a shorter duration of surgical intervention, a low amount of blood loss and a lower incidence of complications in the early periods. The primary patency of the operated segment after hybrid techniques was higher than after open and endovascular surgical interventions.

Keywords

Peripheral arterial disease / hybrid intervention / claudication

References

[1] Krotovsky GS, Zudin AM. Tactics of treatment of patients with critical ischemia of the lower extremities. Available from: http://textarchive.ru/c-1061963.html. [Last accessed on 26 Oct 2018] (in Russian)

[2] Nicoloff AD,McLafferty RB,Porter JM.Patient recovery after infrainguinal bypass grafting for limb salvage.J Vasc Surg1998;27:256-63

[3] Rutherford RB,Ernst C,Porter JM.Recommended standards for reports dealing with lower extremity ischemia: revised version.J Vasc Surg1997;26:517-38

[4] Dosluoglu HH,Cherr GS,Dryjski ML.Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease.J Vasc Surg2010;51:1425-35

[5] Glushkov NI,Artemova AS,Maksimkina ES.The infection in vascular surgery and metabolic syndrome: a coincidence or correlation?.Kardiologiya I Serdechno-Sosudistaya Khirurgiya2017;10:56-61(in Russian)

[6] Russian Society of Surgeons. National recommendations for the management of patients with diseases of arteries of lower extremities. Available from: http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/upload/disease_arteries.pdf. [Last accessed on 26 Oct 2018] (in Russian)

[7] Matsagkas M,Arnaoutoglou E,Labropoulos N.Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis.Ann Vasc Surg2011;25:1063-9

[8] Uchkin IG,Talov NA,Gonsales AK.Experience with hybrid techniques of surgical treatment of patients with lower limb critical ischaemia.Angiol Sosud Khir2013;19:48-57(in Russian)

[9] Koidan AA,Vavilov VN,Atmadzas AV.Comparative results of various methods of arterial reconstruction in the defeat of the femoral-popliteal segment in patients with chronic critical ischemia of the lower limbs.Reg Blood Circ Microcir2017;16:41-8(in Russian)

[10] Gordon IL,Arefi M,Stemmer EA.Three-year outcome of endovascular treatment of superficial femoral artery occlusion.Arch Surg2001;136:221-8

[11] Clark TW,Soulen MC.Predictors of long-term patency after femoropopliteal angioplasty: results form the STAR registry.J Vasc Interv Radiol2001;12:923-33

[12] Cvetanovski MV,Cvetanovska M,Colanceski R.Femoropopliteal bypass vs percutaneous transluminal angioplasty and stenting in treatment of peripheral artery diseases of infrainquinal segment - short-term results.Priloz2009;30:105-18

[13] Glushkov NI,Artemova AS.Results of various revascularization methods in patients with critical ischemia of the lower limbs in the background of peripheral atherosclerosis.Kardiologiya I Serdechno-Sosudistaya Khirurgiya2017;10:50-6(in Russian)

[14] Zatevakhin I,Zolkin V..Balloon angioplasty in ischemia of lower limbs2004;MoscowMedicine Pub(in Russian)

[15] Eroshkin IA,Vasilev UG.Results of endovascular methods for the treatment of critical ischemia of the lower limbs in patients with diabetes mellitus.Int J Interv Cardioangiol2008;14:36-36a(in Russian)

[16] Antoniou GA,Karathanos C,Koutsias S.Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease.Eur J Vasc Endovasc Surg2009;38:616-22

[17] Schillinger M,Baumgartner I.TASC II section F on revascularization: commentary from an intervencionist’s point of view.J Endovasc Ther2007;14:734-42

[18] Troitskiǐ AV,Khabazov RI,Lysenko ER.Outcomes of hybrid operations in multi storeyed lesions of arteries of the aortoiliac and femoropopliteal segments.Angiol Sosud Khir2012;6:67-77(in Russian)

[19] Nishibe T,Dardik A,Koizumi J.Hybrid surgical and endovascular therapy in multifocal peripheral TASC D lesions: up to three-year follow-up.J Cardiovasc Surg (Torino)2009;50:493-9

[20] Thomas M.Treatment of chronic lower limb ischemia. In: Jonathan DB, editor. Vascular and endovascular surgery2006;USAElsevier35-6