This journal is
indexed in Scopus
Year 2018 Vol. 26 No 5
GENERAL & SPECIAL SURGERY
O.F. SOVTUS, R.V. SABADOSH
USE OF ENDOVASCULAR AND COMBINED INTERVENTIONS IN OBLITERATING OCCLUSIVE-STENOTIC ARTERIAL DISEASES OF THE LOWER LIMBS
Ivano-Frankivsk National Medical University, Ivano-Frankivsk,
Objective. To improve the results of treatment in patients with lower limb artery occlusive-stenotic diseases, where open operations are impossible or involve a high risk, by using endovascular interventions.
Methods. 53 patients have been treated, they underwent endovascular revascularization of lower limb artery different segments (I group – aortoiliac with or without femoropopliteal; IIÀ – femoropopliteal; IIB – femoropopliteal and infrapopliteal; III – infrapopliteal) with/without of the additional open operations on other segments. During the year a technical success of the procedures, the primary and secondary patency of intervention zones, the frequency of conservation and the degree of limb ischemia were assessed.
Results. The technical success was achieved in 94.3% of patients, 1-year secondary patency was achieved in 92.5%, the preservation of the lower limbs was achieved in 96.2%. In group I, where 60% of patients underwent hybrid operations (endovascular stage - on aortoiliac segment), a positive technical result was obtained in all the patients; stent thrombosis, necrotic processes, ischemia above grade IIA (Fontaine) were not observed during one year. Identical results were obtained in the IIA group. In the III group, which was based on patients with total occlusion of the lower leg and foot main arteries or total circular calcification of their post-occlusal segments, the technical success was 84.6%, the one-year primary patency was 76.9%, and limb salvage was 100%. In Group IIB these indicators were 91.7, 75.0 and 83.3%, respectively.
Conclusions. The careful application of endovascular interventions in stenosis and occlusions of the lower limbs arteries allows achieving technical success, primary and secondary patency of the revascularization zone and one-year limb salvage in 88.7-96.2% of patients. Endovascular treatment can be recommended as the method of choice in complete occlusion of the lower leg and foot main arteries, total circular calcification of their post-occlusal segments and for revascularization of aortoiliac segment in case of its combined lesions with the femoropopliteal segment at hybrid operations.
- Mehaffey JH, Hawkins R, Fashandi A, Tracci MC, Cherry K, Kron I, Upchurch G, Robinson WP. Lower extremity bypass is associated with lower short-term major adverse limb events and equivalent major adverse cardiac events compared with endovascular intervention in a national cohort with critical limb ischemia. J Vascr Surg. 2017 Jan;65(Is 1):e4-e5. doi: 10.1016/j.jvs.2016.10.018
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 (Suppl 1):S1-75. doi: 10.1016/j.ejvs.2006.09.024
- Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the european society of cardiology (ESC). Eur Heart J. 2011 Nov;32(22):2851-906. doi: 10.1093/eurheartj/ehr211
- Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):305-68. doi: 10.1016/j.ejvs.2017.07.018
- Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, Yamagu DJ. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg. 2016 Jul;64(1):e1-e21. doi: 10.1016/j.jvs.2016.03.420
- Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34.e1-2. doi: 10.1016/j.jvs.2013.08.003
- TASC Steering Committee, Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Ann Vasc Dis. 2015;8(4):343–57. doi: 10.1177/1358863X15597877
- Olin JW, White CJ, Armstrong EJ, Kadian-Dodov D, Hiatt WR. Peripheral artery disease: evolving role of exercise, medical therapy, and endovascular options. J Am Coll Cardiol. 2016 Mar 22;67(11):1338-57. doi: 10.1016/j.jacc.2015.12.049
- Clair DG, Beach JM. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther. 2015 May;13(5):551-63. doi: 10.1586/14779072.2015.1036741
- Antoniou GA, Georgiadis GS, Antoniou SA, Makar RR, Smout JD, Torella F. Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst Rev. 2017 Apr 3;4:CD002000. doi: 10.1002/14651858.CD002000.pub3
- Goloshchapov-Aksenov RS, Shugushev ZKh, Matveev DV, Maximkin DA, Lakunin KYu. Evaluation of the effectiveness of endovascular treatment of patients with obliterating atherosclerosis of lower limb arteries with long occlusions of the superficial femoral artery. Vestn RUDN. Ser Meditsina.2017;21(2):234-45. doi: 10.22363/2313-0245-2017-21-2-234-245 (in Russ.)
- Gray BH, Diaz-Sandoval LJ, Dieter RS, Jaff MR, White CJ. SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use. Catheter Cardiovasc Interv. 2014 Oct 1;84(4):539-45. doi: 10.1002/ccd.25395
- TASC Steering Committee, Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vasc Med. 2015 Oct;20(5):465-78. doi: 10.1177/1358863X15597877
Ivano-Frankivsk, Galitskaya Str., 2,
Ivano-Frankivsk National Medical University,
Surgery Department of the Stomatological Faculty,
Rostyslav V. Sabadosh
Sovtus Oleg F., Post-Graduate Student of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
Sabadosh Rostislav V., MD, Professor of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.