Tactical and technical considerations in deploying endovascular procedures for chronic threatening lower limb ischemia
DOI:
https://doi.org/10.11603/2414-4533.2023.3.14155Keywords:
chronic threatening lower limb ischemia, endovascular operationsAbstract
The aim of the work: to evaluate new tactical and technical measures in order to increase the efficiency of endovascular operations in chronic threatening ischemia of the lower extremities.
Materials and Methods. We analyzed postoperative results in 286 patients with TCLLI, average age (62±8.2) years, after an endovascular procedures performed in cardiovascular and endovascular center at Ternopil Municipal Hospital No. 2, for the period of 2012–2022 years. The majority were men (187), 99 were women. Limb ischemia, according to Rutherford's classification, was III stage in 69.1 % and 30.9 % was IV stage. According to our findings, the frequency and localization of occlusive lesions using TASC II classification, type A was found in 9.1 % of patients, type B in 49.7 %, type D – in 41.2 % of patients. The length of atherosclerotic occlusions in 57 (20 %) patients was from 15 to 20 cm, in 121 (42.3 %) patients – up to 15 cm, and in 108 cases (37.7 %) more than 20 cm. To eliminate or reduce the symptoms of TCLLI, the following options of endovascular operations were used: vasoballoon dilatation of arteries using the "sliding" technique or the "drilling" technique followed by stenting with a self-expanding stent, subintimal angioplasty, the SAFARI method, retrograde approaches through the distal part of the tibial or posterior arteries of the foot, the transpedal arch technique, the J-loop technique, and the confluent balloon technique.
Results and Discussion. After gathering postoperative results, we can state that clinical success in the first 6 months was achieved in 234 (81.8 %) patients. Among them, a significant improvement in the condition of the limb occurred in 128 (44.9 %) patients, moderate improvement was noted in 100 (35 %) patients, no changes in 35 (12.3 %) cases, and moderate deterioration in 23 (7.8 %) of patients. calculation of the brachial-peroneal index, studying the intensity of the pain syndrome using a digital rating scale.
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