Critical Lower Limb Ischemia Research Articles

Methods for improving the results of using a synthetic prosthesis in the popliteal-tibial segment in critical limb ischemia

Aim. Analysis of immediate and long-term results of using a synthetic prosthesis for femoral-distal-popliteal and tibial bypass grafting in patients with critical lower limb ischemia.
 Materials and Methods. Patients with symptoms of chronic arterial ischemia of the lower extremities in the stage of critical ischemia (n = 109) were operated at the university surgical clinic on the base of D.D. Pletnev City Clinical Hospital, Moscow, in the period from 2009 to 2017. All the patients underwent the operation of femoral-distal popliteal or femoral-tibial bypass grafting using a synthetic explant (PTFE). Shunting with a synthetic prosthesis was performed in 33 (30.3%) patients, and in 76 (69.7%) cases a combination of an explant with a section of autovein was used in the form of a combined shunt in 44 patients (40.4%) (synthetic prosthesis + autovein) or a patch- or cuff plasty of distal anastomosis in 32 patients (29.3 %). In 14 (12.8%) patients of both groups, the intervention was supplemented by intraoperative balloon angioplasty of the lower leg arteries. Long-term results were evaluated within the period up to 5 years after surgery. Kaplan-Meyer survival analysis was used for the calculation of results.
 Results. The cumulative 5-year patency of the synthetic prosthesis was 42.9%. However, use of the prosthesis in combination with the autovein section in the form of a combined shunt or plastic surgery of the distal anastomosis significantly improved the values of cumulative patency (54.5%) and limb retention (83.6%).
 Conclusions. The results obtained make it possible to recommend the use of a synthetic prosthesis in combination with an autovenous plastic surgery of a distal anastomosis or by combining a prosthesis with a small section of an autovein in the absence of a complete autovein. Regular monitoring of such shunts in the long-term period and timely follow-up interventions are necessary for improving long-term results.

Clinical and organizational assessment of endovascular care accessibility at the regional level

The world health care system´s concern of inequalities in treatment of receiving the necessary medical care. The purpose of article to evaluate the availability of endovascular care (EVC) for patients at regional level in Russia and to develop a system for its improvement. As a result the low availability of EVC for the population at the regional level in Russia with coronary heart disease, atherosclerosis of the brachiocephalic arteries and critical lower limb ischemia (CLLI) was funded. The main reasons for the difficulties in obtaining EVC in the regions of Russia are the low frequency of diagnosing a critical stage of cardiovascular disease (CVD) requiring surgical treatment, the absence of cardiovascular surgeons and cardiologists in the medical care organizations, the failure in information to patients attending a regular doctor´s appointment about effectiveness and safety of endovascular treatment technology. More old-school traditional methods remain in place like bypass or endarterectomy surgery. Further obstacles are prolonged waiting list at the regional level for the provision of high-tech care in cardiovascular surgery, choice of conservative treatment methods or amputation of lower limbs for patients with CLLI 3 and 4 st. (p<0.05). In Conclusion the Clinical and organizational assessment of the endovascular care accessibility in CVD for the population in regions of Russia elaborated. One way to improve the situation is the introduction of the cardiovascular care clinical management. A dual-circuit clinical and organizational system was developed and proposed to increase endovascular care accessibility in regions.

Efficiency of the Endovascular Correction of Clinically Evident Degrees of Chronic Obliterating Lower Limb Diseases in Multisegment Lesions

Objective: to evaluate the efficiency and extent of endovascular revascularization in patients with multisegment lesions in chronic obliterating diseases of the lower limb arteries.Material and methods. The outcomes of the endovascular correction of multisegment lesions of the lower limb arteries were analyzed in 10 patients. Results. After the treatment the patients revealed a statistically significant change (increase of the value) of the ankle-brachial index (ABI) (p = 0.001). The ABI value after the surgical intervention amounted to 0.81 (0.71; 0.87), which was connected with a favourable prognosis for such patients. Аccording to the established criteria, the outcomes of the interventions comprised the decrease of the degree of chronic arterial insufficiency (p &lt; 0.01), all the patients were discharged having no clinical manifestations of critical lower limb ischemia or decreased evidence of intermittent claudication.Conclusion. The majority of patients with clinically evident ischemia of the lower limbs suffer from multisegment arterial lesion (the number of the segments exceeds 2), which entails the need of multiple corrections in one patient. Meanwhile, the evaluation of the treatment results is possible only in the postoperative period according to the indirect criteria. Therefore, during the operation there arises the need to develop a method of the objective intraoperative evaluation of the extent and efficiency of the performed correction of arterial lesions on each segment.

Гибридный метод реваскуляризации в лечении критической ишемии нижних конечностей

Гибридный метод реваскуляризации в лечении критической ишемии нижних конечностей

Advantages of modern methods of prevention of thrombotic complications in patients with critical ischemia of lower limbs after reconstructive operations

Aim. To evaluate and improve the results of reconstructive operations in patients with obliterating atherosclerosis with critical ischemia of the lower limbs through reduction of the rate of thrombotic complications by improvement of diagnosis of risk factors for thrombosis on the basis of coagulogram and Thrombodynamics T-2 test data.&#x0D; Materials and Methods. In the I group of patients (n=48) reconstructive operations were performed on the arteries of lower limbs and anticoagulant therapy with unfractionated heparin (UFH) with control of hemostasiogram before the operation, in 6 hours and 6 days after the operation and with additional control of APTT 30 minutes before introduction of UNH. In the II group (n=34) reconstructive operations were performed with selection of anticoagulant therapy using parameters of hemostasiogram and laboratory-diagnostic system Thrombodynamics Recorder T-2 with control before the operation, in 6 hours, 6 days after the operation and with additional control of APTT in 30 minutes before introduction of UFH.&#x0D; Results. Analysis of the data of coagulogram and Thrombodynamics T-2 test showed statistical significance of APTT, fibrinogen, delay and initial speed of clot growth, a combination of which permits a possibility for correction of heparin therapy for prevention of thrombosis.&#x0D; Conclusions. The dynamics of the parameters of Thrombodynamics T-2 test in selection of UFH dose proves high effectiveness of this method for selection of adequate doses of anticoagulant drugs for prevention of postoperative thromboses in patients with critical ischemia of the lower limbs.

Therapeutic potential of a biomedical cellular product in rats with lower limb ischaemia

Critical ischaemia of lower limbs is a cause of death and invalidity in the whole world. Stem cells and products of their secretion find wide application in treatment of vascular diseases, including critical ischaemia of the lower limbs. Erythropoietin promotes an increase in the angiogenic potential of stem cells. The authors examined the therapeutic potential of a biomedical cellular product (mesenchymal stem cells and products of their secretion) and mesenchymal stem cells with erythropoietin on the processes of restoration of vessels in the hind legs of Wistar male rats following induction of lower limb critical ischaemia. Mesenchymal stem cells were derived from the bone marrow of male Wistar rats. Critical ischaemia of hind legs was modulated by transaction of the femoral artery. The parameters of microcirculation in the foot were assessed with the help of laser Doppler flowmetry. In the blood serum and crural muscles by means of solid-phase enzyme immunoassay we examined the levels of cytokines, growth factors, and persistent metabolites of nitrogen oxide - nitrites. Muscles morphology and the number of blood vessels were assessed by the findings of histological examination. It was shown that the biomedical cellular product alone and in combination with erythropoietin stimulated angiogenesis. The results of Doppler flowmetry revealed restoration of the parameters of microcirculation in the lower limb by 35-75% of the baseline values. Besides, we observed a decrease of muscle necrosis, connective tissue proliferation, and an increase in the number of the vessels supplying the muscles in the experimental groups. It was also determined that the biomedical cellular product influenced the levels of cytokines in blood serum and crural muscles. Hence, the obtained findings proved the therapeutic potential of the biomedical cellular product in critical ischaemia of lower limbs.

Multilevel arterialization of the venous bed in treatment of critical lower limb ischaemia

Presented herein is original experience in using a technique of arterialization in patients with critical lower limb ischaemia on the background of diffuse multilevel occlusive lesions of femoral, crural arteries and arteries of the foot in 214 patients. We used a new method of treatment by means of oxygenation of the sural group of muscles and the foot through the small saphenous vein and indirect communicating veins. This method does not require destruction of the valvular apparatus of the communicants themselves, promoting opening of previously not functioning ones, as well as appears to be a powerful stimulus for the development of collateral circulation of the extremity. Alterations introduced into the design characteristics of a valvulotome make it possible to avoid lateral injury of the venous wall in the area of confluence of tributaries, preventing incomplete resection of the valve. The method expands the boundaries of operability of patients with the absence of the receiving arterial bed of the calf and foot. It may be combined with arterial primary and repeat reconstructions in patients with depleted receiving channel of the calf as an effective additional path of outflow. It also makes it possible to lower the level of amputation in the developed necrosis of the distal part of the foot. Based on clinical laboratory and instrumental findings, the patients were diagnosed by the aetiological factor of the occlusive process and its extension, substantiating the indications for operative treatment with the use of one or another venous basin. Comparative assessment of reversion of arterial blood flow through the great saphenous vein, small saphenous vein, and posterior tibial vein, according to the findings of bioelectromagnetic diagnosis of reactivity of tissues demonstrated that the most effective method was that of arterialization thought the small saphenous vein. With the help of the questionnaire of quality of life in patients with performed arterialization of the calf and foot through the small saphenous vein for critical lower limb ischaemia we obtained 5-year remote results. Upon completion of this period, 87.3% of the limbs were saved and composite measures of the patients' quality of life proved to be high, ranging from 53 to 69 points.

Soft tissues regional blood flow and microvasculature upon different perioperative treatment strategies following indirect revascularization in patients with critical lower limb ischemia, caused by occlusion of distal arteries

Soft tissues regional blood flow and microvasculature upon different perioperative treatment strategies following indirect revascularization in patients with critical lower limb ischemia, caused by occlusion of distal arteriesJ.V. Kosayev1*, I.A. Hasanov2*1 Scientific Center of Surgery named after

Does an attempt to save a limb always prolong the patient's life?

The purpose of the study was to examine overall survival and the incidence of major adverse cardiovascular events, as well as economic expenditures for treatment of patients with occlusion of the femoropopliteal-tibial segment and critical ischaemia in low competence of the outflow channel, with a poor prognosis for endovascular or open revascularization of lower-limb arteries. We studied the results of treating a total of 68 patients with lower-limb critical ischaemia and low parameters of the outflow channel competence. Primary arterial reconstruction was performed in 48 cases. At various terms after revascularization due to thrombosis of the reconstruction zone and the development of gangrene, amputation of the lower limb was performed: at 3 to 11 (n=25) and at 12 to 24 (n=25) months. Primary amputation of the lower limb was performed in 20 patients. The endpoints of the study included overall survival, the incidence of major adverse cardiovascular events, and economic expenditures for the in-hospital treatment. The average duration of follow-up amounted to 2 years. The obtained findings demonstrated that in patients with lower-limb critical ischaemia and low parameters of the outflow channel competence, redo arterial reconstructions and amputation within 11 months, as well as a high level of surgical risk were associated with a low overall survival rate and the development of major adverse cardiovascular events in the remote period. Secondary surgical interventions on the major vessels significantly increased the cost of treatment.

Problems and prospects of cell therapy for critical ischaemia of lower limbs

Cell therapy was proposed as a procedure of indirect revascularization for patients with critical ischaemia of lower extremities for whom endovascular and surgical revascularization is impossible. We present herein a review of the state of the art of studies in the field of cell therapy of this cohort of patients. Cell therapy has proved safe, however, the results of studies of efficacy are relatively ambiguous and unconvincing. The number of patients in separately taken clinical trials is minimal. The reviewed studies differed not only by heterogeneity of the cell types used but by the routes of administration of cells (cells were delivered either intramuscularly (predominantly) or intraarterially) and the duration of follow up (time of assessment and duration of follow up varied from 1 month to 2 years). One of the problems became the lack of the routine study of the angiogenic potential of stem cells prior to their clinical application. It is known that the angiogenic activity of multipotent cells of apparently healthy patients may differ from that of patients suffering from atherosclerosis, chronic renal failure, diabetes. It is supposed that treatment with stem cells or precursor cells is more efficient as compared to protein or gene therapy not only owing to direct vasculogenic properties but a paracrine action through excretion of proangiogenic biologically active substances. More studies with larger cohorts are necessary to provide stronger safety and efficacy data on cell therapy. Besides, a promising trend in the field of cellular approaches is modulation of regenerative capability of stem cells, which may help overcome difficulties in understanding the place of cell therapy in therapeutic angiogenesis.

РОЛЬ РЕНТГЕНЭНДОВАСКУЛЯРНОЙ ХИРУРГИИ В ЛЕЧЕНИИ ОБЛИТЕРИРУЮЩЕГО АТЕРОСКЛЕРОЗА АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ У ПАЦИЕНТОВ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА

Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3-5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).

Comparative evaluation of long-term outcomes of various open surgeries on the aortofemoral segment in patients with critical lower limb ischemia

Comparative evaluation of long-term outcomes of various open surgeries on the aortofemoral segment in patients with critical lower limb ischemia

Modified revascularizing osteal trepanation in patients with critical lower limb ischemia and distal arterial lesion

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить особенности стимуляции регионарного кровообращения модифицированной реваскуляризирующей остеотрепанацией (РОТ) у больных с критической ишемией нижних конечностей (КИНК), обусловленной дистальным артериальным поражением. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Исследование проводилось у 121 больного с КИНК. У 48 пациентов проведено стандартное лечение (контрольная группа). Стимуляция регионарного кровотока у 42 больных была проведена стандартной РОТ, у 31 больного — модифицированной нами РОТ с внутрикостномозговым лазерным облучением (ВКЛО). В период стационарного лечения были определены следующие показатели артериального и венозного кровотока: регионарное систолическое давление в положении больного стоя и лежа, градиент регионарного систолического давления, постокклюзионное венозное давление в положении стоя и лежа, градиент постокклюзионного венозного давления, венозно-артериальный индекс в положении стоя и лежа. С целью мониторинга стимуляции кровотока через 3—4 мес после выписки из стационара повторно изучены изменения параметров регионарного кровотока. Параметры регионарного артериального и венозного кровообращения сравнивали с этими же параметрами у 48 практически здоровых лиц (контрольная группа). <h3>РЕЗУЛЬТАТЫ</h3> При поступлении в клинику у больных выявлены выраженные нарушения артериального и венозного звеньев регионарной макро- и микроциркуляции. РОТ и РОТ с ВКЛО достоверно мобилизуют регионарное кровообращение и снижают степень хронической ишемии в сравнении с исходными данными. Эти результаты наиболее выражены у больных после РОТ с ВКЛО. Отмечена достоверная зависимость стимуляции кровотока от хирургической тактики (<i>p</i>&lt;0,001). <h3>ВЫВОД</h3> При невозможности прямой реваскуляризации у больных с КИНК, обусловленной дистальным поражением артерий, стимуляция регионарного кровотока модифицированной РОТ (РОТ с ВКЛО) является обоснованной. Этот подход позволяет улучшить результаты лечения у этой тяжелой категории больных.

Efficacy of treatment of lower-limb critical ischaemia by methods of indirect revascularization

The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.

Morphological changes of muscles of the crus and prevention of postoperative complications at patients with the diabetes mellitus at critical ischemia of the lower extremity

The case history of 57 patients with critical lower limb ischemia in diabetes mellitus in the clinical database of the Bukhara State Medical Institute was studied. All examined patients were taken during surgery 2 grams of muscle tissue from m. soleus and m. gastrocnemius from one anatomical zone from the side of the amputated limb. Biopsy material was studied to determine the microflora and to predict the course of the wound process, and therefore the qualitative and quantitative content of the microbial bodies of the material was determined by bacteriological examination. The morphology of the soleus and biceps muscles was also studied. The results of the study showed a high growth of microbial bodies from the soleus muscle, the reason for this is necrosis of the muscle tissue, which was confirmed by the morphological study.

Comparison of surgical treatment results of critical limb ischemia and analysis off actors influencing the outcome of surgical treatment

Objective. To evaluate the results of surgical treatment of critical limb ischemia in two specialized vascular centers.&#x0D; Materials and methods. The results of surgical treatment of 202 patients with critical lower limb ischemia, which were operated in two specialized vascular centers: I Group (76 patients) -ClinicofVascularSurgery at the Military Hospital, Ruzomberok,Slovak Republic; II Group (126 patients) -ClinicofVascularSurgery, EastSlovakInstituteofCardiovascularDiseases, Kosice, Slovak Republic.&#x0D; Results.The patency of arterial reconstructions in I Group was: the femoro-supragenicular segment: 1 year -83%, 3 years - 73%;the infragenicular segment: 1 year - 68%, 3 years - 52%. In II Group -the femoro-supragenicular segment: 1 year - 91%, 3 years - 82%;the infragenicular segment: 1 year - 72%, 3 years - 64%.&#x0D; Conclusion.The patency of arterial reconstructions during the first year in both vascular centers was without statistical difference. The femoro-supragenicular reconstructions had the best patency over three years (&gt; 70%). The following factors influenced the duration of arterial reconstructions: the type of graft used, diabetesmellitus, smoking.

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.

Efficacy of plasma exchange in patients with ischemia-reperfusion syndrome of the lower extremities

Aim. Optimization of treatment of patients with critical lower limb ischemia in ischemia-reperfusion syndrome by a combination of infusion therapy and plasma exchange.&#x0D; Methods. The study included 58 patients (48 men, 10 women) aged 52 to 87 years (mean age 67.1±6.2 years) operated for critical lower limb ischemia. In the postoperative period all patients received standard conservative treatment. Depending on its effectiveness, the patients were divided into two groups: group 1 (n=30) with a positive response to the treatment and group 2 (n=28) where plasma exchange was required. The indications for plasma exchange were a decrease in the rate of diuresis &lt;0.5 ml/kg/h after the surgery for 4-6 hours, exceeding 5 times the normal values of creatine phosphokinase and 3 times the level of myoglobin.&#x0D; Results. In 48% of patients (group 2), deterioration of the condition was registered, which manifested by deterioration of the state, increase in shortness of breath, decrease in the rate of diuresis. In the laboratory analysis of patients of group 2, attention was drawn to an increase in the level of myoglobin to 287.8±30.1 ng/ml, creatine phosphokinase activity to 1769.3±191.8 u/l, and that of lactate to 2.2±0.3 mmol/l. These parameters exceeded not only the normal values, but also the indicators of group 1. These changes indicated the manifestation of ischemia-reperfusion syndrome and the threat of acute kidney injury. Plasma exchange was accompanied by clinical improvement (decrease in shortness of breath, increase in the rate of diuresis) and pronounced positive dynamics of laboratory parameters. The inclusion of plasma exchange into the complex therapy of ischemia-reperfusion syndrome was accompanied by an increase in the rate of diuresis by 1.7 times (p &lt;0.05), a decrease in the level of myoglobin by 3.1 times (p &lt;0.05) and the activity of creatine phosphokinase by 2.8 times (p &lt;0.05).&#x0D; Conclusion. The use of plasma exchange during the first hours of clinical and laboratory manifestations of ischemia-reperfusion syndrome can prevent the development of fatal complications associated with the progression of this syndrome.

Evaluation of THE Qualitative and the Quantitative Malnutrition, as a Risk Factor for Large Amputations and Re-amputations in Patients with Critical Limb Ischemia

Introduction: Patients with critical limb ischemia are exposed to qualitative and quantitative malnutrition as a result of anorexia caused by chronic pain, insomnia, overuse of analgesics and limitation of mobility. Furthermore, malnutrition is a well-known factor that causes coagulation disorders, immunosuppressions, and directly adversely affects the wound healing process. The aim of this study was to assess the importance of qualitative and quantitative malnutrition in the analysis of the results of revascularization procedures, that is, the frequency as well as the height of amputation, re-mortification, and mortality in patients with critical lower limb ischemia. Methods: The study analyzed the results of laboratory tests: the level of total protein, albumin, hemoglobin, iron, vitamins (A; E and B12) and biometrics (BMI, MNA scale) 200 patients between 50-85 years of age who were admitted to the hospital urgently due to critical lower limb ischemia (grade III and IV on the Fontain scale). All 200 patients were qualified for either surgical revascularization or primary amputation. The results of the analysis of the nutritional status of the patient with the results of surgical treatment are summarized. The endpoint of the study was either primary limb amputation or limb reamputation within 30 days after the first operation. Results: More than 65% of the patients with critical lower limb ischemia had symptoms of quantitative and qualitative malnutrition. Of which more than 45% of patients were extremely undernourished, both qualitatively and quantitatively. Due to severe mental and physical degradation in the group of patients with extreme malnutrition, the primary proportion of large amputations in patients was 33%. In the control group without malnutrition 3% The proportion of secondary large amputations after revascularization procedures in extremely malnourished patients was 15%, while in the control group 1%. Conclusion: Among the surveyed patient population, extreme malnutrition was an important predictor of the loss of the diseased lower limb even after effective revascularization. Disclosure: Nothing to disclose

2-D Perfusion Angiography: Is it the Evolving Technology of Choice for Predicting the Outcomes of Endovascular Interventions in Lower Limb Critical Ischemia

Introduction - The primary goal of revascularization is not only to recanalize vessels to the foot, but also to obtain a better wound perfusion, and thus, better healing and limb salvage. A technology is needed which can determine periprocedurally whether a successful recanalization is sufficient to resolve rest pain or achieve wound healing, and thus have the ability to predict clinical outcome. 2-D Perfusion angiography is one such emerging technology that presents the physiological perfusion state as a colour-coded display, where different colours represent corresponding perfusion levels.