EFFICACY OF DISTAL REVASCULARIZATION IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Abstract

Critical limb ischemia (CLI) leads to an increase in the above-the-knee amputations and mortality, which can reach 40 %.
 The aim of the study is to improve the results of treatment in patients with CLI by including endovasal revascularization methods in complex therapy.
 Materials and Methods. The results of surgeries on lower limb arteries in 189 patients were analyzed; among them 110 patients were diagnosed with CLI. The study enrolled 74 men (67.3 %), and 36 women (32.7 %). The average age was 68 years old. Patients underwent color duplex ultrasound scanning (CDUS) and CT angiography. Along with surgical revascularization, patients were prescribed antibacterial, anticoagulant, antiplatelet and insulin therapy (those with diabetes mellitus).
 Results. 110 patients with CLI underwent endovascular revascularization: balloon angioplasty – 110 (100 %), stenting – 54 (49.1 %), hybrid surgeries – 9 (8.2 %), atherectomy and mechanical aspiration – 9 (8.2 %). 88 patients with CLI (80 %) were also diagnosed with multilevel lower extremity arterial disease, and only 22 patients (20 %) had segmental lesions. Above-the-knee amputation was performed in 4 patients, below-the-knee amputation was conducted in 2 patients. Out of 110 patients, 7 people died (6 %). Out of 103 patients, 97 people (94 %) preserved foot balancing function.
 Conclusion. In patients with CLI and distal arterial bed, endovascular revascularization prevented above-the-knee amputation in 94%. Thus, it allowed us to maintain foot balancing function in patients.