ENDOVASCULAR ANGIOPLASTY FOR MULTI-LEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED IN CASES OF STENOTIC-OCCLUSIVE PROCESS OF THE TIBIAL ARTERIES
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2022.1.13157Keywords:
vascular surgery, endovascular angioplasty, stenotic-occlusive process, atherosclerosis, revascularizationAbstract
Background. Occlusive-stenotic lesions of the lower extremity arteries are the second in the structure of cardiovascular diseases, after only coronary heart disease. Surgical treatment of patients with infrainguinal atherosclerotic lesions of the arterial segment is challenging in a number of cases. At the same time, revascularizing surgical interventions on the femoral-distal artery and especially on the tibial arteries in chronic critical ischemia is the only chance to avoid amputation of the lower limb. In this regard, the search and study of optimal methods of revascularizing surgery on the infrainguinal artery for stenotic-occlusive lesions of the arteries of the tibial segment is urgent.
Objective. This study is aimed at promotion of endovascular and hybrid technology in cases of stenotic-occlusive process of the tibial arteries and choosing the optimal surgical treatment tactics in this case.
Methods. Endovascular interventions of the femoral-distal arterial bed in cases of stenotic-occlusive process of the tibial arteries performed for 135 patients at the Department of Vascular and Cardiac Surgery of Ternopil Regional Clinical Hospital have been analysed.
Results. In most cases, endovascular angioplasty of two tibial arteries in hybrid and endovascular methods of revascularization of multilevel atherosclerotic process of the femoral-distal arterial segment of the lower extremity prevents development of thrombosis in tibial segment and allows maintaining the patency of the reconstruction segment and preservation of the lower extremity in 97.57% and 93.44% of cases, respectively.
Conclusions. Endovascular angioplasty of two tibial arteries provides a better result than angioplasty of one isolated tibial artery and allows maintaining the patency of the reconstructed segment for more than 90 percent compare to one isolated angioplasty.
References
Rollins K, Jackson D, Coughlin P. Meta-Analysis of Contemporary Short- and Long-Term Mortality Rates in Patients Diagnosed With Critical Leg Ischemia. Journal of Vascular Surgery. 2014;59:9.
https://doi.org/10.1016/j.jvs.2013.11.010
Neville R, Lidsky M, Capone A, Babrowicz J, Rahbar R, Sidawy A. An Expanded Series of Distal Bypass Using the Distal Vein Patch Technique to Improve Prosthetic Graft Performance in Critical Limb Ischemia. European Journal of Vascular and Endovascular Surgery. 2012;44:177-2.
https://doi.org/10.1016/j.ejvs.2012.04.014
Raju R, Mathur K, Ayyappan M, Vijayakumar J, Venkatesan V, Venkatachalapathy B. Composite sequential bypass using profunda vein hitchhike. Journal of Vascular Surgery. 2016;64:526-9.
https://doi.org/10.1016/j.jvs.2016.04.050
Nolan B, De Martino R, Stone D, Schanzer A, Goodney P, Walsh D, Cronenwett J. Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass. Journal of Vascular Surgery 2011;54:730-6.
https://doi.org/10.1016/j.jvs.2011.03.236
Maurel B, Lancelevee J, Jacobi D, Bleuet F, Martinez R, Lermusiaux P. Endovascular Treatment of External Iliac Artery Stenoses for Claudication with Systematic Stenting. Annals of Vascular Surgery. 2009;23:722-8.
https://doi.org/10.1016/j.avsg.2008.05.019
Nakayama M, Sakamoto F. Proximal direct endarterectomy combined with simultaneous distal endovascular therapy for chronic full-length occlusion of the superficial femoral artery in elderly patients. Asian Journal of Surgery. 2013;136:104-10.
https://doi.org/10.1016/j.asjsur.2012.11.006
Menard M, Farber A. The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for patients with critical limb ischemia. Seminars in Vascular Surgery. 2014;27:82-4.
https://doi.org/10.1053/j.semvascsurg.2015. 01.003
Motaganahalli R, Menard M, Koopman M, Farber A. BEST Endovascular Versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) Trial. Vascular and Endovascular Review. 2020.
https://doi.org/10.15420/ver.2019.12
Hicks C, Najafian A, Farber A, Menard M, Malas M, Black J, Abularrage C Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia. Vascular Medicine. 2016;22:28-4.
https://doi.org/10.1177/1358863x16676901
Gentile F, Lundberg G, Hultgren R. Outcome for Endovascular and Open Procedures in Infrapopliteal Lesions for Critical Limb Ischemia: Registry Based Single Center Study. European Journal of Vascular and Endovascular Surgery. 2016;52:643-9.
https://doi.org/10.1016/j.ejvs.2016.07.013
Tan H, Zhang L, Guo Q, Yao Y, Sun S, Wang T, Li Y, Xiong K. “One-Stop Hybrid Procedure” in the Treatment of Vascular Injury of Lower Extremity. Indian Journal of Surgery. 2013;77:75-8.
https://doi.org/10.1007/s12262-013-0897-1
Borgia F, Di Serafino L, Sannino A et al. AngioJet® rheolytic thrombectomy for acute superficial femoral artery stent or femoropopliteal by-pass thrombosis. Monaldi Archives for Chest Disease. 2015.
https://doi.org/10.4081/monaldi.2010.271
Kobza I, Yarema Y, Zhuk R, Fedoriv D. Reconstructive operations on pedal arteries in the treatment of critical limb ischemia. UMJ Heart &Vessels. 2018;1:37-9. [In Ukrainian]
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