Year 2020 Vol. 28 No 1




4th City Clinical Hospital named after N.E. Savchenko 1, Minsk,
The Republic of Belarus

The cause of 50-70% of cases of the circulatory disorders decompensated forms with the development of critical lower limb ischemia (CLLI) is multilevel obliterating lesions of the peripheral arteries. During the first year from the diagnosis of CLLI, 25% of patients require primary high amputation. The use of small diameter arteries for the formation of a distal anastomosis, an increase in the length of the shunt with ultra-distal bypass surgery, diffuse damage to the artery wall, causes unfavorable hemodynamics in the shunt.
The frequency of early shunt thrombosis after open reconstructions is 25-35%; infectious complications make up 4-21%. A significant drawback of interventional procedures is the extreme difficulty or inability to carry out the intervention with multiple and extended occlusive lesions. A promising direction in solving this problem is the use of hybrid technologies. Despite the apparent simplicity of solving the problem, there is a high probability of developing restenosis after performing endovascular balloon dilatation (EBD). However, the widespread use of balloon catheters and drug-eluting stents has reduced the number of restenoses by 16%. The use of hybrid technologies for multilevel lesions ensures arterial patency of 76% of patients, preservation of the limb in more than 80% of patients, within 3 years after revascularization, which in turn led to a decrease in mortality to 11%

Keywords: critical ischemia, atherosclerosis, revascularization, hybridmethod, thrombosis, bypass
p. 92-99 of the original issue
  1. Martini R. Trends of the treatment of Critical Limb Ischemia during the last two decades. Clin Hemorheol Microcirc. 2018;69(4):447-56. doi: 10.3233/CH-170352
  2. Uccioli L, Meloni M, Izzo V, Giurato L, Merolla S, Gandini R. Critical limb ischemia: current challenges and future prospects. Vasc Health Risk Manag. 2018 Apr 26;14:63-74. doi: 10.2147/VHRM.S125065. eCollection 2018.
  3. Zabolevaniia arterii nizhnikh konechnostei: klin rekomendatsii [Elektronnyi resurs]. Moscow: MZ RF; 2016. 87 p. Rezhim dostupa: (In Russ.)
  4. Aboyans V, Ricco JB, Bartelink MEL, 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, Document Reviewers, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tuñón J, de Ceniga MV, Windecker S, Zamorano JL. Editors 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 Mar;55(3):305-68. doi: 10.1016/j.ejvs.2017.07.018
  5. Rossiiskii Konsensus: diagnostika i lechenie patsientov s kriticheskoi ishemiei nizhnikh konechnostei. Moscow, RF; 2002. 40 p. (In Russ.)
  6. Ianushko VA, Turliuk DV, Ladygin PA, Isachkin DV. Sovremennye podkhody diagnostiki i lecheniia mnogourovnevykh porazhenii arterii nizhnikh konechnostei nizhe pakhovoi skladki v stadii kriticheskoi ishemii. Novosti Khirurgii. 2011;19(6):115-28. (In Russ.)
  7. Karam J, Stephenson EJ. Critical limb ischemia: diagnosis and current management. JMHIF. 2017 Fall/Winter;1(2):124-29. doi: 10.21925/mplsheartjournal-D-17-00004
  8. Belov YuV, Vinokurov IA. The concept of surgical treatment of critical limb ischemia Kardiologiia i Serdech-Sosud Khirurgiia. 2015;8(5):9-13. doi: 10.17116/kardio2015859-13 (In Russ.)
  9. Sieggreen M. Understanding critical limb ischemia. Nursing. 2008 Oct;38(10):50-55; quiz 55-6. doi: 10.1097/01.NURSE.0000337237.72205.8a
  10. Gordon IL, Conroy RM, Arefi M, Tobis JM, Stemmer EA, Wilson SE. Three-year outcome of endovascular treatment of superficial femoral artery occlusion. Arch Surg. 2001 Feb;136(2):221-28. doi: 10.1001/archsurg.136.2.221
  11. Werk M, Albrecht T, Meyer DR, Ahmed MN, Behne A, Dietz U, Eschenbach G, Hartmann H, Lange C, Schnorr B, Stiepani H, Zoccai GB, Hänninen EL. Paclitaxel-coated balloons reduce restenosis after femoro-popliteal angioplasty: evidence from the randomized PACIFIER trial. Circ Cardiovasc Interv. 2012 Dec;5(6):831-40. doi: 10.1161/CIRCINTERVENTIONS.112.971630
  12. Tepe G, Zeller T, Albrecht T, Heller S, Schwarzwälder U, Beregi JP, Claussen CD, Oldenburg A, Scheller B, Speck U. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med. 2008 Feb 14;358(7):689-99. doi: 10.1056/NEJMoa0706356
  13. Scheinert D, Scheinert S, Sax J, Piorkowski C, Bräunlich S, Ulrich M, Biamino G, Schmidt A. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005 Jan 18;45(2):312-15. doi: 10.1016/j.jacc.2004.11.026
  14. Troitsky AV,Khabazov BI, Parshin PYu, Gryaznov OG, Lysenko YeR, Orekhov PYu, Zaitsev MV, Shabaltas YeD, Malyutina YeD. Combined operations for multilevel lesions of the aortoiliac and femoropopliteal segments. Angiologiia i Sosud Khirurgiia. 2005;11(2):113-22. (In Russ.)
  15. Zatevakhin II, Shipovskii VN, Zolkin VN. Ballonnaia angioplastika pri ishemii nizhnikh konechnostei: ruk dlia vrachei. Moscow, RF: Meditsina; 2004. 256 p. (In Russ.)
  16. Papoyan SA, Abramov IS, Maytesyan DA, Verigo AV, Eremenko AG, Baldin VL, Kirsanov Yu K. Hybrid interventions in treatment of chronic ischemia of the lower limbs. Grudnaia i Serdech-Sosud Khirurgiia. 2012;(3):52-56. (In Russ.)
  17. Sabekov RD, Mufassalov RK, Zhussupov SM. Surgical tactics in critical lower limb ischemia in patients with chronic heart failure. Science & Healthcare. 2018;20(3):74-87. (In Russ.)
  18. Schrijver AM, Moll FL, De Vries JP. Hybrid procedures for peripheral obstructive disease. J Cardiovasc Surg (Torino). 2010 Dec;51(6):833-43.
  19. Cotroneo AR, Iezzi R, Marano G, Fonio P, Nessi F, Gandini G. Hybrid therapy in patients with complex peripheral multifocal steno-obstructive vascular disease: two-year results. Cardiovasc Intervent Radiol. 2007 May-Jun;30(3):355-61. doi: 10.1007/s00270-005-0296-5
  20. Nishibe T, Kondo Y, Dardik A, Muto A, Koizumi J, Nishibe M. Hybrid surgical and endovascular therapy in multifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino). 2009 Aug;50(4):493-99.
  21. Fareed AbdElmieniem, Zaid N, Alkhateep Y. Hybrid revascularization techniques in the management of multiple level peripheral vascular disease. Egypt J Surg. 2018;37(1):96-103. doi: 10.4103/ejs.ejs_122_17
Address for correspondence:
220036, Republic of Belarus,
Minsk, Rosa Luxemburg Str., 110,
4th City Clinical Hospital
Named after N.E. Savchenko,
Vascular Surgery Department.
Tel. mobile: +375 29 1421893,
Evgenij V. Nelipovich
Information about the authors:
Nelipovich Evgenij V., Angiosurgeon, Vascular Surgery Department, 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
Yanushko Vyacheslav A., MD, Professor, Chief Researcher of the Laboratory of Vascular Surgery, Republican Scientific and Practical Center Cardiology, Minsk, Republic of Belarus.
Klimchuk Ivan P., PhD, Head of the Vascular Surgery Department, 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
Contacts | ©Vitebsk State Medical University, 2007-2023