Chronic Lower Limb Ischemia Research Articles

КИСЛОРОДТРАНСПОРТНАЯ ФУНКЦИЯ И ГАЗОТРАНСМИТТЕРЫ КРОВИ ПРИ ХРОНИЧЕСКОЙ АТЕРОСКЛЕРОТИЧЕСКОЙ ОККЛЮЗИИ ПОВЕРХНОСТНОЙ БЕДРЕННОЙ АРТЕРИИ И ПОСЛЕ ПЕТЛЕВОЙ ЭНДАТЕРЭКТОМИИ

Background. The restoration of arterial blood flow does not guarantee the restoration of adequate oxygenation of the tissues of the lower extremity after chronic ischemia.Purpose. To study the patterns of changes in oxygen transport function (OTF) and blood gas transmitters in patients who underwent loop endaterectomy (LEAE) from the superficial femoral artery (SFA).Material and methods. We examined 103 patients with occlusion of SFA, which was eliminated by the method of LEAE. The OTF indices, the content of nitrogen monoxide and hydrogen sulfide were determined before the operation as well as on the third and eighth day of the postoperative period.Results. The obtained data suggested an increase in the saturation of venous blood with oxygen and concentration of gas transmitters in сhronic ischemia and after LEAE.Conclusions. The revealed patterns substantiate the effectiveness of LEAE for chronic lower limb ischemia.

A Comparative Study between the Routine Using of Ultrasound Guidance versus Anatomical Guidance in Femoral Artery Access for Endovascular Treatment of Chronic Lower Limb Ischemia

The goal of this study is comparison between the using of ultrasound guidance versus anatomical guidance in femoral artery access for endovascular treatment of chronic lower limb ischemia, by assessment of first pass success rate, total number of attempts required for access, rate of accidental venipunctures, rate of PFA puncture and time to sheath insertion, and assessment of post procedural puncture site complications defined as bruises or hematoma formation. The study found that US guidance is superior to anatomical guidance in femoral artery access in endovascular treatment of chronic lower limb ischemia in reducing access time, total number of punctures, and number of incidental venipuncture, the incidence of PFA access and incidence of local bruises.

RESULTS OF INSPECTION AND TREATMENT OF PATIENTS WITH STENOSIS OF CAROTIDS IN COMBINATION WITH PATHOLOGIES OF OTHER SYSTEMS

Summary. An aim of work is an analysis of results of inspection and treatment of patients with the hemodynamically meaningful defeat of carotids in combination with pathology of other organs and systems. Materials and methods. The results of treatment are analysed 187 patients with hemodynamically by meaningful stenosis of carotids in SI «Zaycev V.T. IGUS of NAMSU» from 2015 for 2018 on a background forthcoming surgical treatment of chronic ischemia of lower limbs, ischemic heart or pathology of gastrointestinal tract trouble. Patients are divided into 3 groups. The first group was made by patients with the chronic ischemia of lower limbs of 2-Д degree - 167 patients. 7 patients entered a group with pathology of gastrointestinal tract. 3 a group was made by 13 patients with ischemic heart trouble. Results and discussion. The direct results of operation we estimated complex on the basis of degree of change of clinical status and presence of postoperative complications. At 161 the patients of the first group in a postoperative period are not educed complications, for a 2th patient thrombosis of anastamosis and ischemic stroke, at 4th paresis of n. Hypoglossuss. In the second group for all operated patients concerning stenosis of carotid, complications were not in a postoperative period. For one patient with the cancer of stomach, that was not execute a reconstructive operation on a carotid an ischemic stroke developed in connection with bleeding. In 3 cases in a postoperative period observed symptomatology of stroke for patients operated concerning ischemic heart, carotid endarterectomia was not executed these patients. Conclusions. To the patients with general atherosclerosis and stroke in anamnesis it is necessary to conduct carotids screening. At hemodynamically meaningful stenosises patients with heart diseaseby and pathology of abdomen of must execute carotid endarterectomia of the first stage, that reduces the risk of ischemic stroke in a postoperative period at treatment of basic pathology.

Design of clinical prospective study: application of gene, cell therapy and indirect revascularization for treatment of patients with non-reconstructive chronic lower limb ischemia

The aim — to improve the results of surgical treatment of patients with chronic critical lower limb ischemia.Materials and methods. To organize the study, we chose the open controlled method of parallel groups. The study was planned and conducted as an open prospective randomized and controlled trial. The study was conducted in four stages: 1st (screening, up to 2 weeks) — evaluation of the possibility of involvement in the study. At this stage all examinations of patients were carried out; 2nd (2 days) — signing informed consent, distribution of the patients to the treatment groups; 3rd (1.5 months) — treatment; 4th (3 years) — observation. The study involved patients whose vascular bed surgical reconstruction was impossible due to: the presence of prolonged occlusion of the femoral artery with the transition to the distal bed; destruction of vessels of distal segments with unfavorable prognosis; previously performed reconstructive interventions on the arteries of the lower extremities, which did not eliminate chronic ischemia due to the impossibility of repeated surgery; decompensation of somatic pathology that could interfere with surgery.Results and discussion. 110 patients were selected for treatment. The patients were divided into three groups according to the treatment method: 1st — 48 patients who underwent revascularization osteotreopenia as an operation of indirect revascularization, 2nd — 21 patients who were administered endothelial cell growth factor drug for stimulation of their own angiogenesis, 3rd — 41 patients in whom subcutaneous fat sampling, cultivation and transplantation of autologous mesenchymal cells were performed according to proposed by us method. To compare the main endpoints of the study, we created a control group of patients, who had previously undergone the treatment by standard methods in the clinic. The criteria for inclusion in the treatment groups and control group did not differ. All patients in the treatment groups had a high level of pain (on average > 70 mm on a visual analog scale) in the affected limb. The most common associated pathologies were hypertension and coronary heart disease. There was no statistically significant difference in the anamnestic data. Many patients had a history of revascularization attempts (> 50 % had one attempt, 20 % had two or more), 42 % had previous amputations including 26.4 % of small amputations and 10.9 % of above‑knee amputations. The most common reason why patients in the treatment groups were not subject to the revascularization procedure was the technical impossibility of intervention (56.4 %), less common reason — the inappropriateness (33.6 %), which was evaluated on the Finnvasc scale.Conclusions. Critical lower limb ischemia is the most severe form of peripheral artery disease and is associated with a high risk of amputation of the affected limb and death. Three groups of patients, comparable in age, sex ratio, concomitant pathologies and clinical characteristics of the underlying disease, were selected for the prospective study. To compare the effectiveness of our treatment we selected a control group of patients retrospectively, by case histories, according to the inclusion criteria which were the same for all groups. This group was somewhat artificially created, as it consisted only of selected patients comparable to persons in treatment groups by age, comorbidities and underlying disease, as well as those patients whose treatment outcomes could be traced over a 3‑year follow‑up period.

Arm Veins in Bypass for Chronic Lower Limb Ischemia Provide Durable Late Results

Arm Veins in Bypass for Chronic Lower Limb Ischemia Provide Durable Late Results

Comparative Study of the Results of a Three-year Observation of Cardiologists and Surgeons in Patients with Peripheral Atherosclerosis

Aim.To compare the results of 3-year follow-up of patients with peripheral atherosclerosis (PA) in two patient cohorts: during outpatient monitoring by cardiologists and when observed by surgeons.Material and methods. The first group included 131 patients with PA who sought medical attention in outpatient clinic in 2013-2014 and then were observed by a surgeon. The second group is represented by 454 patients with PA who sought medical attention in outpatient clinic in 2010- 2012 and then underwent observation by a cardiologist as a part of a pilot project. The average follow-up duration in the studied groups was three years. The groups were compared according to the main demographic, anthropometric indicators, the presence of risk factors for atherosclerosis, comorbidity, the prevalence of atherothrombotic events in history, laboratory and instrumental examination data. Additionally, after 3 years of observation the incidence of deaths and amputations was assessed in groups.Results. Patients of the second group were older than these in the first group (p<0.001). Patients of the group 1 compared to the group 2 were more often overweight (p=0.005), suffered from diabetes mellitus (p<0.001), had a disability (p<0.001). Among patients of the group 2 compared with the group 1, the clinical picture of angina pectoris (p=0.001), rhythm disorders (p=0.058) were more often observed, they had a greater number of myocardial infarctions (p<0.001) and myocardial revascularization operations in the history: coronary bypass surgery (p=0.029), percutaneous coronary interventions (p<0.001), and underwent coronary angiography (p<0.001). Patients in group 2 were more likely to receive statins (p<0.001), β-blockers (p<0.001), angiotensin-converting enzyme inhibitors, and calcium channel blockers, angiotensin II receptor blockers, and antiarrhythmics (p<0.001). Pentoxifylline was prescribed more often in the first group (p<0.001). With a three-year observation of PA patients a fatal outcome occurred in 8.2% of cases, amputation – in 1.4%. In the first group, compared with the second one, there were more often observed deaths in general (p=0.023), death from cardiac causes, stroke, disability (p=0.005) and amputations (p=0.003). The risk of adverse outcomes (death and amputations) was increased in the presence of signs of chronic lower limb ischemia of stage III, a history of amputation, more than 70% stenosis and occlusions of lower limb arteries, chronic lung disease, and angina symptoms. The risk of adverse outcomes was decreased in outpatient observation by cardiologist, taking statins, aspirin, and performing exercise therapy.Conclusion. Observation of PA patients by a cardiologist results in more frequent optimal drug therapy (due to the better adherence of cardiologists to clinical recommendations for the treatment of such patients) and improves the prognosis of these patients.

Endovascular treatment of chronic lower limb ischemia - the first experience of consecutive patients in the Kyrgyz Republic

Objective: Pure atherosclerosis and diabetes mellitus are often responsible for the lesion of lower limb arteries. As a result, critical ischemia may develop. Endovascular treatment of lower extremities chronic ischemia in the modern world one of the most effective methods of limbs salvage. This report is an analysis of the first experience of endovascular treatment in consecutive patients with chronic lower limb ischemia in the Kyrgyz Republic. Methods: In 2016-2018, there were 31 patients with chronic lower limb ischemia in IIb-IV Fontaine's stages who underwent endovascular treatment. The primary endpoint was 6-month painlessness or reduction of the Fontaine stage; freedom from amputation up to six months; active regenerative process or full recovery of ulcers/wounds up to six months. The secondary endpoints included 6-month all-cause mortality and reintervention rate. Results: Overall, 27 (87.1%) patients reached painless form (stage I according to Fontaine (ABI ≥0.9)), with complete regeneration or active reparative process observed in 20 (64. 5%) patients. In general, major amputation was avoided in 29 (93.5%) patients (two patients underwent amputation by E. Burgess). Minor amputations were performed below the level of foot dorsum (Sharp) in 35.5% (11 patients). Simultaneous percutaneous coronary interventions and peripheral interventions were performed in 6 (19. 4%) cases. In total, within 6 months one death was registered (3.2%). Conclusion: The first endovascular treatment of consecutive patients showed encouraging 6-month results. Simultaneous («Ad-hoc») or stepwise (at the current hospitalization) procedures on coronary and peripheral arteries ensure safety and can provide more chances of patient`s survival.

Feasible Evaluation of PQ Bypass Results with Duplex Ultrasound

Abstract Patients with peripheral arterial disease (PAD) have substantially impaired health-related quality of life (HR-QoL). Chronic lower limb ischaemia due to the atherosclerotic occlusion of infra-inguinal arteries is one of the most important causes of invalidity among smokers over the age of fifty. Historically, these lesions were treated by open bypass surgery. Less invasive endovascular revascularisation methods are available to treat short lesions, while treatment of long lesions are lacking. Fully endovascular trans-venous femoro-popliteal bypass (PQ Bypass, Inc., Sunnyvale, CA, USA) to treat long femoral lesions has been developed recently. The objective of the study was to evaluate duplex ultrasound (DUS) as a tool to follow up patients after PQ bypass procedure. A prospective clinical study was conducted at one clinical site. DUS of treated arteries and femoral vein was performed before the procedure, 30 days, 6 months, and 12 months in follow-up period by 2 independent radiologists. Ankle-brachial index (ABI) evaluation was performed at all visits. Thirty-five patients (35 limbs) treated with PQ bypass were enrolled in the study. Median age was 63.6 years (ranged 50 to 87 years). There was 100% successful evaluation of all patients at all clinical visits available. Deviation of the DUS results was found within the accepted standard limit between two radiologists. Twelve months after the PQ procedure, 28 (80.0%) PQ stent-grafts were still functioning without DUS signs of stenosis, while seven (20.0%) limbs experienced varying degrees of stent malfunction. PQ stent-graft occlusion was detected in five (14.3%) – 1 (2.9%) patients at one-month follow-up, 3 (8.6%) at six months and 1 (2.9%) at twelve months follow-up period, respectively. PQ stent-graft proximal junction stenosis was detected in one patient (2.9%) at six months and distal junction stenosis in one patient (2.9%) at twelve months follow-up, respectively. Despite of graft occlusion found with DUS, two patients had no severe worsening of post-operative ABI. DUS is a reliable method to evaluate patients after PQ bypass procedure and has higher sensitivity than ABI to follow-up patients after PQ procedure, especially in asymptomatic stent stenosis. Regular and timely use of DUS during the postoperative period may help to recognise potential complications and provide effective treatment..

Progression of chronic lower limb ischemia in a patient with occlusion of the infrarenal aorta after myocardial revascularization using the internal thoracic artery: a clinical case

Progression of chronic lower limb ischemia in a patient with occlusion of the infrarenal aorta after myocardial revascularization using the internal thoracic artery: a clinical case

Zachowania zdrowotne wśród pacjentów z przewlekłym niedokrwieniem kończyn dolnych

Introduction. Atherosclerotic obliterans of the lower limb arteries are characterized by the formation of atherosclerotic plaques that accumulate inside the walls of the arterial vessels. It is the most common form of atherosclerosis that causes narrowing and/or complete closure of the main vessels that supply blood to the extremities. There are atherosclerosis risk factors that can be modified by taking appropriate health behaviors. Aim. The aim of the study was to assess the level of health behaviors among patients with chronic lower limb ischaemia. Material and methods. The study group consisted of 70 patients, including 51 men and 19 women. The method of diagnostic survey was used in the work. The author’s questionnaire and Zygfryd Juczyński’s Inventory of Health Behaviors questionnaire were the research tools. Results. Most of the respondents defined their health behaviors on an average level, and among the four categories of behavior the best results were obtained in the category of correct eating habits, especially in women and in people with higher education. In health practice, better results were obtained by patients suffering from more than two years of illness, for people with a disease lasting several months. Conclusions. There is a need for health education for patients with chronic lower limb ischemia, in which special attention should be paid to proper nutrition, regular physical activity and mobilization to stop smoking.

Long-term results of complex therapy in patients with nonreconstructible chronic lower limb ischemia

The aim — to improve the results of surgical treatment of patients with chronic critical lower limb ischemia by developing methods of autologous transplantation of multipotent stem mesenchymal stromal cells, administration of endothelial cells growth factors and therapeutic and diagnostic measures to preserve the lower limb or reduce the level of its amputation, reduce ischemia and the frequency of disability of such patients, improve their quality of life.Materials and methods. The study included 110 patients with a clinical picture of pain at rest, ischemic edema, and trophic changes (IIIA, IIIB, and IV stage of lower limb ischemia according to the classification of the European Association of Angiologists and Vascular Surgeons) caused by nonreconstructible occlusive and obliterating diseases of lower limb arteries. The patients were divided into three groups according to the method of treatment: in the 1st group (n = 48), revascularization osteotrepanation was performed as an operation of indirect revascularization, in the 2nd group (n = 21) a drug of endothelial cells growth factor was administered to stimulate their own angiogenesis, in the 3rd group (n = 41) subcutaneous fat was collected, autologous mesenchymal cells were cultivated and transplanted according to the developed technique. The control group of patients (n = 50) was selected retrospectively according to the case histories in accordance with the criteria of involvement and the results of treatment which could be followed up in a 3‑year observation period.Results and discussion. The safety of the lower limb in the 3rd group was statistically more significant than in the 1st and 2nd groups and remained at the level of 82 % after three years of observation. The smallest number of large amputations was in the 3rd group (2.3 % — above knee‑joint and 7.3 % — below, knee‑joint whereas in the control group the number was 18 % and 24 %, respectively).Conclusions. The level of high amputations directly affects the life expectancy of patients. Only treatment in the 3rd group reduced the risk of large amputation compared with the control group (odds ratio 2.752 (95 % confidence interval — 1.12 — 6.733)). Only treatment in the 3rd group reduced the risk of amputation compared with other types of treatment (odds ratio 0.358 (95 % confidence interval 1.111 — 1.158).

Clinical Outcome of Infrapopliteal Angioplasty for Treatment of Chronic Lower Limb Ischemia

Background: Chronic lower limb arterial stenosis is a condition that impairs the quality of life and could result in amputation. One of the major treatments is angioplasty to open the stenosis. Objectives: We evaluated the midterm results of endovascular treatment of infra popliteal arterial disease as a primary intervention to reduce the level of ischemia in order to avoid major amputation. Patients and Methods: Between March 2013 and April 2015, we collected all data of patients who underwent infrapopliteal angioplasty for chronic limb ischemia (CLI), (Rutherford category 4,5, or 6). The outcome as freedom from reintervention, limb salvage, improvement of signs and symptoms, and the overall survival was analyzed. We reviewed the results of angioplasty by anatomic characteristics of the lesion, transatlantic intersociety characteristics (TASC). Results: Forty seven patients were enrolled in this study of whom 37 were male. Mean age was 67.2 years. Mean ankle brachial index (ABI) before and 6 months after percutaneous transluminal angioplasty (PTA) was 0.5 ± 0.07 and 0.68 ± 0.12, respectively (P < 0.01) and an improved ABI of at least 0.1 was detected in 78% of the patients. In 97.2%, initial technical success was obtained. Rest pain was completely resolved in 66.7% of the patients after the 3-month follow-up and 72.7% after the 6-month follow-up after the procedure. Complete or relative healing of chronic ulcer was seen in 69% and 92% of patients in the 3- and 6-month follow-up after the procedure, respectively. Restenosis occurred in four patients (8.5%), major amputation in 19.1% (9 patients) and the mortality rate was 25.1% (12 cases). Primary patency was finally estimated as 76.1%. Conclusions: PTA for infrapopliteal lesions in high-risk patients can reduce the risk of amputation with a lower mortality and morbidity.

Role of Retrograde Transpopliteal Angioplasty for Superficial Femoral Artery Occlusion

Background: surgical interventions are indicated for patients with peripheral arterial disease (PAD) who developed CLI or debilitating IC that is refractory to conservative management; while bypass, with an autologous vein or prosthetic conduit, is the mainstay of open surgical management of PAD. On the other hand, the percutaneous endovascular interventions has emerged as an alternative effective, and safe, treatment option in patients with PAD. Objective: the aim of the study was to evaluate the effectiveness and safety of the retrograde popliteal approach for recanalization of long segment occlusion of superficial femoral artery in cases with chronic lower limb ischemia. Patients and Methods: this is a prospective study conducted on 30 patients presenting to Al-Azhar University Hospitals and Mataria Teaching Hospital; all of them have chronic lower limb ischemia due to proximal long segment occlusion of superficial femoral artery (SFA) after failure to pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach. Results: ankle brachial index (ABI) is a commonly used surrogate marker of atherosclerosis. In the present study, the rate of complications was relatively low (16.7%) in which pseudoaneurysms were encountered in 10% and arteriovenous fistulae were encountered in 6.7% of the patients. Conclusion: retrograde popliteal approach is feasible, safe, and effective technique for the management of CTO of superficial femoral artery in patients with failure of pass through the antegrade access either by the ipsilateral or by the contralateral femoral approach.

TO CORRELATE THE CHRONIC LOWER LIMB ISCHEMIA WITH COLORDOPPLER FINDINGS

Patient admitted in Anand Hospital, Indore from 2017 Dec to 2018 Dec to a minimum of 50 cases.&#x0D; Total 1(2%) patient was found to have grade a abi, 13(26%) with grade b abi, 5(10%) patients with grade c abi and 31 (62%) patients with grade dabi. Color dopplerfindngs were consistent with clinical findings.&#x0D; In color doppler diagnosed atherosclerosis patients, 13 (50%) were those with raised serum cholesterol (grade a), 13 were grade b (&lt;250mg/dl s. cholesterol) i.e. (50%). While in buerger's disease 9 were found to be grade a (37.5%) and 15 were found to be grade b (62.5%). Higher association of grade a (&gt;250mg/dl) was found with atherosclerosis.&#x0D; Clinical study is very efficient, elaborative and explanatory in making the diagnosis of chronic lower limb ischemia and color doppler well conforms to the observations and deductions made by the clinical analysis in the study of PAD.&#x0D; Keywords: Chronic, Lower Limb, Ischemia &amp; Colordoppler.

Profundoplasty in treatment of patients with chronic lower limb ischaemia

The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV. Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years. Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.

Тактический подход к этапному лечению больного хронической ишемией нижних конечностей в сочетании с ишемической болезнью сердца

Тактический подход к этапному лечению больного хронической ишемией нижних конечностей в сочетании с ишемической болезнью сердца

Conservative treatment of chronic lower limb ischemia in ambulatory practice (in Russian only)

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.

Clinical study of efficacy and safety of Aducil in patients with chronic lower limb ischaemia

The study was aimed at assessing efficacy and safety of treatment with Aducil® (cilostazol) compared with Trental® 400 in patients with moderate-to-severe intermittent claudication due to peripheral atherosclerosis. The study included a total of one hundred and forty-five 36-to-75-year-old patients. The participants were distributed into 2 groups according to the inclusion/exclusion criteria in a 2 to 1 proportion: patients in group 1 received Aducil® 100 mg BID, in group 2 - Trental® 400 TID for 12 weeks. 142 subjects completed the protocol. Analysis of the effectiveness of treatment according to the primary criterion showed a better effectiveness of Aducil® as compared with Trental® 400. Subjects who received Aducil® had a higher increase in the absolute maximum walking distance after 12 weeks of treatment as compared with those taking Trental® 400: 126±110 m versus 45±39 m, respectively (р<0.001). Subjects who received Aducil® had a statistically significant improvement in quality of life parameters such as physical and mental health components according to the SF-36 questionnaire after 12 weeks of treatment (р≤0.01). Subjects in Aducil® group had better quality of life with an increase from 34 to 40 points according to the physical component score, while patients in Trental® 400 group demonstrated minor positive changes (from 35 to 37 points); mean mental component score increased from 45 to 48 points in Aducil® group as compared with an increase from 45 to 47 points in Trental® 400 group. While self-reported physical health status was similar between the groups at baseline, subjects in Aducil® group reported better physical functioning after treatment (р=0.016). Two adverse events were registered in two subjects in Aducil® group. Analysis of the study endpoints demonstrated that Aducil® had better treatment effectiveness in patients with chronic lower limb ischemia stage IIB according to the classification of A.V. Pokrovsky-Fontaine as compared with Trental® 400, while the safety profile and drug tolerance were similar between the two.

Treatment of necrotizing infection in patients with chronic arterial insufficiency of the lower extremities

To analyze the effectiveness of complex therapy of necrotizing infection using the original method of stimulation of angiogenesis in patients with chronic arterial insufficiency of the lower extremities. In 53 patients, operations were performed using the proposed technologies for stimulation of angiogenesis. A control group consisting of 56 patients was formed to compare the results of treatment. They had standard vascular therapy for the correction of ischemia. Morphological studies of the muscles of the lower extremities included assessment of capillary bed density and spatial orientation of the capillaries before and after treatment. Computed angiography of the lower extremities followed by calculation of perfusion index was performed to assess changes in the microvasculature. Clinical evaluation of the results was carried out using R. Rutherford scale. Revascularization resulted significant augmentation of capillary bed density and the number of functioning capillaries in muscular tissue. This was accompanied by increased perfusion index and TcPO2 values. The effect of treatment is observed in 12-14 days after surgery and persists for a long time. The best outcomes are found in patients with ischemia grade IIb-III. Incidence of lower limb amputations was more than 2 times lower in the main group compared with the control group. Combined stimulation of angiogenesis including mechanical tunneling of the muscles of the affected limb and administration of platelet rich plasma is effective procedure. This method does not require complex equipment and may be used in the treatment of patients with complications of chronic lower limb ischemia and contraindicated direct arterial reconstruction.

Femoropopliteal bypass for chronic lower limb ischemia: A prospective cohort study and single center cases series

BackgroundPeripheral occlusive arterial disease (POAD) is a steadily increasing global epidemic. Femoropopliteal bypass (FPB) is the traditional therapeutic option whenever endovascular treatments failed or not indicated. We present our experience in lower limb revascularization. Patients and methodsProspective observational cohort single center study included 158 patients with intermittent claudication (IC) or critical limb ischemia (CLI). The patients were placed in 7 Rutherford categories & their angiographic findings were graded according to Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) criteria. The ipsilateral great saphenous vein was used for revascularization. Resultsmale patients were 113 (71.5%); female were 45 (28.5%). Age ranged from 39 to 77 years, with a mean of 60.7 ± 7.8 years. About 79.1% of patients were in the 6th & 7th decades. Only 26 patients (16.5%) had severe IC & 83.5% had CLI. Almost all patients with Rutherford category 3–6 had an ankle brachial index (ABI) less than 0.70. Most Femoropopliteal lesions (n = 115, 72.8%)near half infrapopliteal lesions (n = 74, 46.8%) were of TASC II B & C types. Majority of patients received a vein graft. Distally, 100 grafts (66.7%) were sutured below the knees whereas the remainder were either behind (n = 31) or above the knees (n = 8). The follow up ranged from 1 month to 11 years. One & 5 year patency rates of vein grafts were 88.7% & 70.2% respectively. ConclusionsFPB using saphenous graft yield a very good graft patency, low rates of amputation, morbidity and mortality. Long-term patency is excellent.