Abstract
Introduction. Critical limb ischemia (CLI), which arises from atherosclerotic lesions of the arteries is quite often presently. This problem is actively discussed all over the world. In addition to the disability of the patients due to limb loss, the death rate from this disease is comparable to mortality from malignant tumors. Objective. Evaluate immediate and long-term results and optimize treatment tactics for patients with critical limb ischemia in multilevel lesions of lower limb arteries. Materials and methods. The examination and treatment of patients with CLI was carried out in the Research Institute of Surgery and Urgent Medicine of the First State Medical University of Saint-Petersburg named by I. P. Pavlov, as well as on the basis of the City Clinical Hospital «City Hospital No. 14» and St. Petersburg Research Institute of Emergency Care named by I. I. Dzhanelidze in the period from 2005 to 2016. The study is conducted in patients with atherosclerotic lesion of the main arteries of the lower extremities, which manifests itself as pain at rest and/or tissue loss (stage 3-4 of chronic arterial insufficiency of the limb according to Fontein-Pokrovsky classification). Results. Clinical success of all kinds of interventions was achieved in 166 (88.8 %) patients. However, the negative results were greater in the group where only angioplasty of the lower limb arteries was performed. Long-term results could be traced in 108 (57.8 %) patients for 6 months - 5 years. If we consider all groups as a whole, then the aggravation of ischemia occurred in endovascular intervention group in 62 % of patients, in the group of bypass operations - in 19.61 %, and in the group of hybrid interventions - in 17.65 %. Conclusion. Hybrid methods of treatment are the method of choice for patients with stage 4 ischemia of the lower limb with multilevel lesions of lower extremity arteries. Open surgery on the arteries of the lower extremities remains a very effective method of treating patients with critical ischemia. In turn, the use of endovascular methods is advisable in patients with severe concomitant pathology.
Highlights
Critical limb ischemia (CLI), which arises from atherosclerotic lesions of the arteries is quite often presently
In addition to the disability of the patients due to limb loss, the death rate from this disease is comparable to mortality from malignant tumors
The study is conducted in patients with atherosclerotic lesion of the main arteries of the lower extremities, which manifests itself as pain at rest and/or tissue loss
Summary
При выполнении ангиопластики артерий бе дренно-подколенного сегмента (группа II) тактика зависела от вида и протяженности поражения. Нами были построены куму лятивные кривые по рецидиву насту пления КИНК и сохранению конечно сти по методу Каплана–Мейера Мы решили детально рассмотреть судьбу пациентов с критической ише мией нижних конечностей в стадии ишемии 4 по Покровскому–Фонтейну. 4. Кумулятивная частота сохранения конечности после различных методов лечения пациентов с КИНК: кумулятивная частота сохранения конечности через 2 года в группе I составила 70 %, в группе II – 32 %, в группе III – 59,5 %. Hybrid revascularization procedures in acute limb ischemia // Ann. Vasc. Brillu C., Piquet J., Villapadierna F. et al Percutaneous transluminal angioplasty for management of critical ischemia ней нижних конечностей показал гибридный метод. Реконструктивные операции на артериях, вы полненные открытым способом, позволяют адекват но восстановить кровоток для пациентов со степенью ишемии III или с незначительными трофическими расстройствами. Гибридные методы лечения являются методом выбора для больных IV стадией ишемии при много уровневом поражении артерий нижних конечностей.
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