Crural Arteries Research Articles

Inframalleolar Bypass to the Distal Portion of the Lateral Tarsal Artery for Limb Salvage.

A 72-year-old man was admitted to our hospital due to rest pain and gangrene on his left second foot digit. Angiography revealed continuous patency from the superficial femoral artery stent to the below-knee popliteal artery with a diffuse, occlusive lesion in the crural arteries. The distal portion of the lateral tarsal artery was patent. Popliteal to lateral tarsal artery bypass was performed, and an immediate amputation of the second foot digit resulted in secondary healing. Vascular surgeons should consider the distal portion of the lateral tarsal artery as an effective alternative target for infragenicular revascularization.

Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries.

AIMTo examine the efficacy and safety of the 6 French (6F) Rotarex®S catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODSThe files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex®S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.RESULTSTwo patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex®S catheter. Additional Rotarex®S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSIONMechanical debulking using the 6F Rotarex®S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.

Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia?

Acute limb ischemia is a vascular emergency defined as a sudden decrease in limb perfusion associated with a risk of loss of viability of the affected extremity. Surgical treatment (Fogarty thromboembolectomy) is indicated only in suprainguinal occlusions. Other cases of acute and subacute limb ischemia should be managed percutaneously. Catheter-based treatment involves local thrombolysis and percutaneous mechanical thrombectomy (PMT). There are several devices in use for PMT; of them, the Rotarex system appears to be the most useful. There are no randomized studies comparing thrombolysis and PMT. Only indirect comparison is possible. The immediate and long-term results of PMT using the Rotarex device are probably more favorable than those following thrombolysis. Particularly for older and polymorbid patients, it may be significant that PMT, in comparison with thrombolysis, can restore blood flow faster and in one session; no contraindications for PMT in contrast to potentially life-threatening complications in thrombolysis exist, and there is also no need for observation in intensive care unit after PMT. Hospital stay after PMT is shorter. There is only one exception when thrombolysis cannot be replaced by Rotarex PMT - in the case of crural arteries involvement - due to the catheter size. In our opinion, PMT is superior to thrombolysis in the treatment of acute and subacute limb ischemia. Thrombolysis should be considered only in special cases, e.g. in crural arteries occlusions or in failure of mechanical thrombectomy.

Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report

Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.

Risk stratification for silent coronary artery disease in patients with type-2 diabetes mellitus: Contribution of vascular duplex ultrasound

Coronary artery disease (CAD) is one of the main causes of death in patients with type-2 diabetes mellitus (T2DM), but is often atypical or asymptomatic. The aim of the study was to investigate the contribution of peripheral vascular ultrasound data in the risk stratification of silent CAD. From 2010 to 2012, 541 patients with T2DM without cardiovascular (CV) history attended a CV screening consultation, including clinical, ECG and carotid and peripheral Duplex ultrasonography. According to findings, they were referred to a screening test for ischemic heart disease, and, if necessary, subsequent coronary angiography. Silent CAD was defined as ≥ 2 ischemic segments on stress cardiac imaging or as abnormal coronary angiography. Patients without chest pain and without ischemia on ECG represented 79% of the population, with a prevalence of silent CAD of 4% in this group. Medial calcinosis (MC) of crural arteries ( OR = 5.6; 95% CI: 1.96–15.9, P = 0.001) and the presence of ≥ 3 other CV risk factors ( OR = 3.2; 95%CI: 1.1–9.4, P = 0.038), were significantly associated with silent CAD. By excluding patients without any of these 2 parameters (55%), the coronary screening can be focused on a subgroup of patients at high risk (7.8%) for silent CAD, with a negative predictive value of 99.5%. Vascular Duplex ultrasound can improve the risk stratification for silent CAD in T2DM patients.

Association between crural vessel patency and successful transmetatarsal amputation: a single centre experience

Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (2006-2015). TMA was considered successful by the absence of a higher-level amputation. Follow-up was for a minimum of 12 months. 24 patients (21 male; mean age 64 years) were studied. TMA was successful in 16 (67%). On statistical analysis, successful TMA was not significantly associated with vessel patency in either superficial femoral artery (SFA), or any single or combination of named crural artery. TMA healing can be achieved in the absence of a patent posterior tibial artery. We support the role of TMA in selected patients, given its benefits compared to transtibial amputation.

Endovascular Stent Grafting in Posttraumatic Tibial Artery Pseudoaneurysms: Case Report

AbstractInfrapopliteal pseudoaneurysms are rare and usually occur secondary to trauma. Though there are no consensus regarding the management of the same, endovascular treatment has become an alternate option to open surgical management. In this report, we describe two cases of posttraumatic infrapopliteal pseudoaneurysms involving crural arteries. Both the cases were managed successfully with endovascular stent graft placement with complete exclusion of pseudoaneurysm. Our results show that endovascular stent grafting is a good alternative to open repair in infrapopliteal pseudoaneurysms, although long-term efficacy of this approach needs to be established.

Abstract P238: Cardiovascular Risk Factors for Intimal and Medial Calcification in a High-risk Population

Introduction: Arterial calcification is associated with an increased cardiovascular risk. Intimal calcification has long been held responsible for this association, whereas the role of medial calcification was unclear. Hypothesis: We hypothesize that the risk factor profile in patients with high cardiovascular risk differs for those with intimal or medial calcification of the lower extremity arteries. Methods: We conducted a cross-sectional study of 203 patients included in the Second Manifestations of ARTerial Disease (SMART) study, comprising of patients with CVD as well as patients at high risk for CVD, who underwent CT (computed tomography) scanning of the lower extremities. Calcification in the femoral and crural arteries was scored as absent, dominant intimal, dominant medial or indistinguishable according to a previously validated algorithm scoring linearity and circularity. We fitted multinomial regression models assessing the associations of cardiovascular risk factors with different patterns of calcification. Results: No calcification was present in 18% for the femoral and 28% for the crural arteries, while prevalence of intimal calcification was 44% and 38%. Medial calcification prevalences were 25% and 20% for the femoral and crural arteries, respectively. We found considerable consistency in the predominant calcification pattern of the crural and femoral arteries (linear weighted Cohen’s kappa [0.41, 95%CI 0.29-0.52]). Patients with dominant medial calcification were older, more often male and more often had diabetes than patients with intimal calcification. Conversely, patients with intimal calcification were more often smokers than patients with medial calcification. In multinomial logistic regression models, age was a significant risk factor for all types of calcification compared with no calcification. Male sex was associated with an increased risk of medial calcification [OR femoral 10.37, 95%CI 2.14-50.32], but not with intimal or indistinguishable calcification, compared with no calcification. Current smoking was associated with intimal calcification[OR femoral 3.25, 95%CI 0.98;10.83], but not with medial calcification. No significant relationships were found with other cardiovascular risk factors. Conclusions: Within the same individual, a predominant arterial calcification type (intimal or medial) often exists throughout the lower extremity. These patterns of calcification appear to have different associated risk factor profiles.

Endovascular surgery for critical ischemia of lower extremities with suppurative-necrotic lesion of the feet

To improve treatment of patients with grade IV chronic ischemia of lower extremities via endovascular angioplasty combined with surgical methods for suppurative-necrotic lesions of the feet. 51 patients with grade IV chronic ischemia of lower extremities underwent endovascular interventions (balloon angioplasty, stenting). A total of 23 stents were deployed in 16 patients including 12 stents in superficial and common femoral arteries, 5 in popliteal artery, 6 in iliac artery. There were no stents in crural arteries. The most perspective artery for wound healing was preferred in case of revascularization below popliteal segment. Necrectomy was performed along with angioplasty in patients with suppurative-necrotic lesion of the feet followed by delayed reconstructive operations if it was necessary. Endovascular surgery for grade IV chronic ischemia of lower extremities was associated with good immediate results in most cases due to revascularization and organ-sparing interventions for suppurative lesions of the feet. Current endovascular methods allow to perform successful re-operations to restore blood flow in previously repaired arteries and implanted stents with restenosis or thrombosis.

CLINICAL RESULTS OF ANGIOPLASTY DEPENDING ON THE NUMBER OF RESTORE OF CRURAL ARTERIES AND BLOOD FLOW IN THE ARTERIAL ARCH OF THE FOOT IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Aim . Was evaluated clinical results of transluminal balloon angioplasty (PTA) in patients with critical ischemia, depending on the opening ratio of crural arteries and restore blood flow in the arterial arch of the foot. Material and Methods. Results of treatment of 63 patients with critical limb ischemia, who underwent technically successful transluminal balloon angioplasty (PTA). Results. Clinical success was 79.4%, and was statistically significantly associated both with the opening ratio (p=0.01), and with the restoration of blood flow on arterial arch of the foot (p<0.001). The number of small and large amputations in the case of restoration of arterial arch of the foot was significantly less (p<0.001). The filling of the arc via peroneal artery provide a clinical result comparable to the result of revascularization of the foot through one of the main arteries of the tibia (p=0,18). Conclusion . Clinical success of the procedure associated with the technical features of the PTA is conducted as with the restoration of the arc, and with the number of open arteries of the lower leg.

The extent of atherosclerotic lesions in crural arteries predicts survival of patients with lower limb peripheral artery disease: A new classification of crural atherosclerosis

Background and aimsSeveral studies report correlation of ankle brachial index (ABI) values and mortality. However, no studies exist on the predictive value of anatomical distribution of atherosclerotic lesions and the extent of atherosclerosis at defined arterial segments on life expectancy. The aim of the present study was to evaluate the significance of both extent and localisation of atherosclerotic lesions to mid-term patient survival. MethodsDigital subtraction angiography (DSA) images of 887 consecutive patients admitted to the Department of Vascular Surgery at Turku University Hospital (Turku, Finland) were retrospectively analysed. Each angiography was classified according to the TASC II classification for aorto-iliac and femoro-popliteal segments, and a similar four-grade index was created for crural arteries. Patients were followed until 36-months post DSA. ResultsDuring 36-month follow-up 295 (33%) deaths occurred. Death during follow-up was strongly associated with extensive crural disease, but not with extensive proximal disease (Crural Index III-IV, p = 0.044 and < 0.001, respectively). In a Cox regression analysis incorporating baseline variables, Crural Index IV and most severe atherosclerosis on crural vessels were the strongest predictors of poor prognosis (HR 2.20 95% CI 1.3–3.7, p = 0.003 and HR 2.45 95% CI 1.5–4.0, p < 0.001 respectively). ConclusionsThe extent of crural atherosclerosis is independently associated with poor mid term life expectancy. Therefore, a classification of the extent of crural atherosclerosis could serve as an indicator of mortality among PAD patients and aid in clinical decision making.

3:18 PMAbstract No. 150 - Balloon angioplasty of the crural arteries: angiographic and clinical long-term follow-up

3:18 PMAbstract No. 150 - Balloon angioplasty of the crural arteries: angiographic and clinical long-term follow-up

Long-term results after balloon angioplasty of crural arteries. Which factors influence leg salvage and survival rates?

Clinical and statistical study analysing factors with influence on success rates, procedure-related complications, and long-term results for patients who underwent angioplasty of the crural arteries. Retrospectively we evaluated all patients who underwent angioplasty of the crural arteries due to critical chronic limb ischemia or severe claudication in the time period from 1/2002 to 12/2005. These patients were contacted in the time period from 1/2009 to 12/2010, and a follow-up examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring physicians for follow-up. 212patients with a mean age of 77.8years (99women and 113men) underwent crural angioplasty on 239limbs. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and patency rate. The prognostic relevance of treatment and selected variables with respect to limb salvage and patient survival were analysed with multiple logistic regression. The technical success rate was 98.4%. Between 1/2009 and 12/2010, 49.5% of the patients died. An angiographic follow-up study was performed in 49.9% of the treated legs. The primary patency-rate (72% after 6months and 62.8% after 12months) was significant, influenced only by the riskfactor dialysis (p= 0.0207). After a mean follow-up of 3.7years, 48patients (22.6%) experienced minor- or major-amputation on 53legs (22.2%). The limb salvage rate (Kaplan-Maier estimation) was 85.4% after 5years. The mean survival rate according to Kaplan-Meier was 79.7, 72.2, 67.3 and 51.4% after 1, 2, 3 and 5years, respectively. Results of multiple logistic regression analysis showed that negative prognostic variables with respect to patient survival were amputation (p= 0.0017) and dialysis (p= 0.0011) and with respect to limb salvage dialysis (p< 0.0001) and non-patent peroneal artery (p< 0.0001). Balloon angioplasty of the crural arteries shows a high technical success rate with an acceptable complication rate. Dialysis and non-patent peroneal artery are negative prognostic variables for the clinical long-term success.

Segurança de procedimentos endovasculares arteriais dos membros inferiores em ambulatório – análise retrospetiva e codificação hospitalar

AimRetrospective analysis of complications in a consecutive group of patients submitted to lower limb arterial endovascular procedures, comparing ambulatory and inpatient settings. MethodsDemographic and clinical details were collected from the clinical files of patients and a statistical software package (SPSS) was used for data analysis. ResultsFrom February 2010 to February 2012, 129 endovascular procedures were performed in 122 patients diagnosed with chronic lower limb ischemia. Twenty‐six patients were admitted to a day surgery unit. In total there were 13 procedural complications reported. Three hematomas were registered as puncture site complications with no intervention needed. Remote complications reported: AV fistulas in the crural arteries, spontaneously resolved; occlusion of the tibioperoneal trunk in one patient that subsequently was submitted to femoro‐posterior tibial bypass with vein conduit for worsening limb ischemia. One patient suffered transient worsening of his basal renal failure. There was no report of further systemic complications, need of ward admission or delay in hospital discharge for both group of patients. ConclusionGiven the relative low complication rates, its immediate identification and control as in this report, we admit that the majority of endovascular peripheral arterial procedures may be performed in ambulatory units. Further investigation should be pursued to disclose factors that may help select patients who better fit in an outpatient profile. The impact of costs in each health care setting should be taken into account in such shift towards ambulatory.

Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses.

The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18-92 years (median 72 years). In all, 128 procedures were performed. Angiographic success was obtained in 120 interventions (93.8%). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention--percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5%. Major amputation was performed in 10% of cases. Cumulative patency rates were 75% after one month, 71% after six months, 38% after 12 months, 33% after 18 months and 30% after 24, 30, 36 and 42 months. Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.

Angiojet Thrombo-aspiration Guided by Trans-Oesophageal Ultrasound.

IntroductionA 59 year old woman presented with acute right leg ischemia. On the computed tomography scan, thrombi were seen in the brachiocephalic trunk, in the descending aorta, in the infrarenal aorta, in the right deep femoral artery, and in the right crural arteries.TechniqueTo remove the risk of cerebral emboli, thrombo-aspiration of the brachiocephalic trunk was planned, with associated thrombectomy of the infrarenal aorta, the right deep femoral artery, and the right crural arteries. Because the brachiocephalic thrombus could not be visualized with angiography, the anesthetists, who were performing a trans-oesophageal ultrasound of the heart, were asked to locate the thrombus, which was easily seen on the trans-oesophageal ultrasound. The aspiration catheter Angiojet (Boston Scientific, Marlborough, MA, USA) could be positioned under ultrasound guidance. Complete aspiration of the thrombus was then confirmed with the ultrasound (see video). The thrombectomy of the infrarenal aorta and right leg was then performed by open surgery. The patient's recovery was uneventful. Despite extensive investigations no etiology was found for the thrombi.DiscussionPre-operative trans-oesophageal ultrasound is routinely performed by anesthetists in patients with acute ischemia, to search for a cardiac source of emboli. In this case it had the added advantage of helping to locate and aspirate a thrombus in the brachiocephalic trunk.

Long Term Results of Inframalleolar Bypass for Critical Limb Ischaemia

Introduction: Distal peripheral arterial disease (PAD) causing critical limb ischaemia (CLI) has become more common as a result of increasing incidence of diabetes. Endovascular treatment has challenged bypass surgery as first line treatment in crural and foot arteries, although long term results of these interventions are lacking. The aim of this study was to evaluate long term results of infra-malleolar bypasses. Methods: Three hundred and fifty two infra-malleolar bypasses for CLI at our institution between 2002–2013 were included in to this retrospective study. Risk factors were evaluated and patency, leg salvage, survival and amputation free survival (AFS) were assessed. All patients who were alive without amputation were invited to clinical control and patency of grafts was assessed using duplex ultrasound. Results: The median follow up time 29 months (range 1 –163 months). The median age of study population was 73 years and 67% of patients were male. The incidence of diabetes was 69%. In majority of cases (78%) the indication for bypass surgery was ulcer or gangrene and 18% of patients had rest pain. All except four bypasses were performed using vein graft. At 1, 5 and 10 years primary patency was 71.2%, 58.2% and 45.3%, assisted primary patency was 76.8%, 68.5% and 54.4%, and secondary patency was 83.2%, 78.1% and 71.9%, respectively. Popliteal artery as inflow artery (n = 194) was associated with superior primary (p = 0.013), assisted primary (p = 0.028) and secondary patency (p = 0.014) compared to bypasses originating from femoral artery (n = 158). The recipient artery did not affect patency, pedal bypasses (n = 281) had equal patency compared to plantar bypasses (n = 71) (p = 0.920). The leg salvage rate at 1, 5 and 10 years was 78.6%, 72.0% and 67.2%. Leg salvage rate was equal in patients with and without diabetes (p = 0.460). The respective survival and AFS rates at 1, 5 and 10 years were 70.3%, 37.4% and 15.9% and 58.4%, 29.8% and 12.8%. Conclusion: Bypass to infra-malleolar arteries is durable treatment option for distal PAD in patients with CLI. These bypasses to foot arteries have excellent long term patency and good limb salvage rate can be achieved both in non-diabetics and diabetics.

Prognostic Significance of Different Strategies of Angiosome Targeted Lower Limb Revascularization

Prognostic Significance of Different Strategies of Angiosome Targeted Lower Limb Revascularization

Blauzdos arterijų endovaskulinių procedūrų ir šuntų į pėdos arteriją rezultatų analizė

Įvadas/tikslas Blauzdos arterijų angioplastika yra vertinga galūnės išsaugojimo procedūra ligoniams, sergantiems kritine kojų išemija. Esant blauzdos arterijų užakimui, dažniausiai atliekama arterijų šuntavimo operacija. Šio tyrimo tikslas buvo parodyti mūsų gydymo rezultatus bei palyginti arterijų šuntavimo operacijų į pėdos arteriją ir blauzdos arterijų perkutaninės transliuminalinės an­gioplastikos vėlyvuosius rezultatus esant kritinei kojos išemijai. Taip pat įvertinti cukrinio diabeto įtaką operacijų rezultatams. Metodai Retrospektyviuoju būdu išanalizuotos visos gydomosios blauzdos arterijų procedūros, atliktos nuo 1999 m. sausio iki 2013 m. gruodžio mėnesio. Buvo palyginti blauzdos arterijų perkutaninės transliuminalinės angioplastikos ir atviros chirurgijos – šun­tų į pėdos arteriją gydymo rezultatai. Išanalizuota cukrinio diabeto įtaka gydymo rezultatams. Rezultatai Sudarytos trys pacientų grupės: I grupė – 193 ligoniai, kuriems atliktos šuntavimo į pėdos arteriją operacijos; II grupė – 103 atvejai 98 pacientams, kuriems atlikta blauzdos arterijų perkutaninė transliuminalinė angioplastika; III grupė – 84 pacientai, kuriems taikytas sudėtinis gydymas – perkutaninė transliuminalinė angioplastika ir šuntavimas į pėdos arteriją. Kumuliacinis kraujotakos atkūrimas po 1 metų atlikus atvirą operaciją – 47,5 %, atlikus blauzdos arterijų angioplastiką – 6,9 %, atlikus sudėti­nį gydymą – 79,6 %. Geriausi rezultatai gauti sudėtinio gydymo grupėje (p&lt;0,007). Galūnės išsaugojimas po vienų metų atlikus operaciją – 84,1 %, po endovaskulinės chirurgijos – 35,4 %, po sudėtinio gydymo – 83,1 %. Ilgesnį laikotarpį galūnės išsaugotos po sudėtinio chirurginio gydymo (p&lt;0,001). Cukriniu diabetu segantiems ligoniams kumuliacinis kraujotakos atkūrimas praė­jus vieniems metams po šuntavimo į pėdos arteriją operacijų – 60,4 %, nesergantiems cukriniu diabetu – 21,8 % (p=0,013), po atliktos blauzdos arterijų angioplastikos cukriniu diabetu sergantiems ligoniams – 3,6 %, nesergantiems – 10,1 %. Kumuliacinis kraujotakos atkūrimas, praėjus dvejiems metams po rekonstrukcinių procedūrų, jei cukrinis diabetas kompensuotas, sudarė 55,2 %, o jei nekompensuotas – 43,6 %. Galūnės išsaugojimas esant kompensuotam cukriniam diabetui sudarė 79,31 %, o nekompensuotam – 61,82 %. Rezultatas nėra statistiškai patikimas (p&gt;0,05). Išvados Blauzdos arterijų angioplastika ir šuntavimo operacija yra tinkamos procedūros išsaugoti galūnę ligoniams, sergantiems kri­tine galūnės išemija. Vėlyvieji kraujotakos atkūrimo rezultatai buvo geresni po šuntavimo į pėdos arteriją atliktų operacijų. Geriausi kraujotakos atkūrimo rezultatai ligoniams, sergantiems cukriniu diabetu, pasiekti taikant sudėtinį gydymo metodą – angioplastiką ir atvirą operaciją. Šuntavimas į pėdos arteriją yra saugi ir efektyvi procedūra cukriniu diabetu sergantiems pacientams, turintiems kritinę kojos išemiją. Glikozilinto hemoglobino kiekis neturi įtakos kraujotakos atkūrimo rezultatams.

Treatment options of crural pseudoaneurysms.

Pseudoaneurysms (PAs) of crural arteries represent rare complications of vascular interventions or surgery. Management of crural PAs includes different treatment options, conservative treatment as well as open surgery or endovascular procedures. We reviewed our experience. We retrospectively analysed all patients who were diagnosed with crural PAs since 2003. We evaluated etiology, treatment and outcome. Endpoints were target vessel patency, vascular re-intervention and limb loss. A total of 30 patients were diagnosed with crural PAs. PA was caused by vascular intervention in 27 patients (90 %): open balloon thrombectomy (n = 25), subfascial endoscopic perforator vein surgery (n = 1) and transcutaneous catheter-assisted thrombus aspiration (n = 1). In 3 patients (10 %) it was caused by orthopaedic surgical procedures. Location of crural PAs were peroneal artery (n = 11; 36.7 %), posterior tibial artery (n = 10; 33.3 %), anterior tibial artery (n = 5; 16.7 %), and tibioperoneal trunk (n = 4; 13.3 %). Treatment of crural PAs included open surgery (n = 3; 10 %), endovascular procedures (n = 13; 43.3 %) such as endograft implantation (n = 9) or coil embolisation (n = 4), and conservative management (n = 14; 46.7 %). After a median follow-up period of 7 months (range: 0 - 46 months) 8 of 9 endografts were occluded, in none of these patients a minor or a major amputation was necessary. None of the surgically, endovascularly and conservatively treated patients needed a re-intervention for crural PA. A major amputation was necessary in 4 patients due to progression of peripheral arterial disease; none was a directly consequence of the crural PA. Crural PAs are mainly caused by vascular intervention, most frequently by catheter thrombectomy. As a consequence, we recommend fluoroscopic-assisted balloon thrombectomy over a guide wire as routine technique. In many cases of crural PAs, conservative management is sufficient. The choice of treatment of crural PAs depends on size, location and associated symptoms. Endovascular treatment using endografts is limited by poor long-term patency.