Evaluation of the effectiveness of endovascular technologies in the treatment of patients with chronic threatening ischemia of the lower extremities
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16487Keywords:
chronic threatening ischemia of the lower extremities, endovascular technologies, revascularization, rotational atherectomy, hybrid interventionsAbstract
The aim of the work: to improve the treatment outcomes of patients with chronic threatening ischemia of the lower extremities based on the evaluation of various methods of reconstructive surgical interventions.
Materials and Methods. For this study, the results of treatment of 245 patients with atherosclerotic lesions of the arteries of the lower extremities in the stage of critical ischemia, who underwent treatment from 2020 to 2025 at the State Scientific Institution "Center for Innovative Healthcare Technologies" of the State Administration of Affairs (Kyiv), were analyzed. The average age of the patients was (66.8±0.71) years. There were 93 men (38 %), 152 women (62 %). For this study, patients were divided into three groups: 85 (34.7 %) patients underwent femoral-popliteal or femoral-tibial bypass (group I); 96 (39.2 %) patients underwent endovascular interventions only (group II); 64 (26.1%) patients underwent hybrid operations (group III). The Rutherford classification (1986) was used to determine the degree of chronic critical ischemia.
Results. The immediate treatment results in all groups were statistically comparable, however, in the long-term period, endovascular interventions demonstrated better rates of no recurrence of chronic threatening ischemia of the lower extremities (CTILE) (71.9 %) and a lower incidence of amputations (9.4 %). The use of modern endovascular technologies, including rotational atherectomy for calcified lesions, allowed for effective restoration of blood flow even in extensive stenotic-occlusive lesions. The results obtained confirm the high effectiveness of endovascular methods of treatment of patients with CTILE in terms of limb preservation and reduction of recurrence rate. Current literature data indicate the expansion of indications for the use of minimally invasive technologies even in extensive and calcified arterial lesions. The use of modern methods of recanalization and atherectomy allows achieving effective treatment results in complex clinical cases.
Сonclusions. Endovascular treatment methods for patients with chronic threatening ischemia of the lower extremities demonstrate high efficacy and provide good long-term limb preservation results. The use of modern revascularization technologies allows for the successful treatment of even extensive and calcified arterial lesions.
References
1. Libby P. The changing landscape of atherosclerosis. Nature. 2021; 592(7855):524-33. DOI: 10.1038/s41586-021-03392-8. DOI: https://doi.org/10.1038/s41586-021-03392-8
2. Boiko VV, Mishalov TV, Voloshyn OV, et al. Sudynna khirurhiia [Vascular surgery]. Boiko VV, editor. Kharkiv. NTMT. 2018; 412. Ukrainian.
3. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019; 58(1S):S1-S109.e33. DOI: 10.1016/j.ejvs.2019.05.006. DOI: https://doi.org/10.1016/j.ejvs.2019.05.006
4. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018; 39(9):763-816. DOI: 10.1093/eurheartj/ehx095. DOI: https://doi.org/10.1093/eurheartj/ehx095
5. Zhang G, Liu X, Li J, Zhao Y, Yuan Z, Chen Y, et al. Global, regional, and national burdens of lower extremity peripheral arterial disease from 1990 to 2021 and projections to 2050: global burden of disease study 2021. Front Cardiovasc Med. 2025; 12:1592322. DOI: 10.3389/fcvm.2025.1592322. DOI: https://doi.org/10.3389/fcvm.2025.1592322
6. Venger IK, Faryna IV. Clinical and laboratory characteristics of reperfusion-reoxygenation syndrome in patients with atherosclerotic aortoiliac-femoral occlusion under chronic limb-threatening ischemia. Zdobutky Clin Exp Med. 2024; 2:40-4. DOI: 10.11603/1811-2471.2024.v.i2.14716 . DOI: https://doi.org/10.11603/1811-2471.2024.v.i2.14716
7. Almasri J, Adusumalli J, Asi N, Lakis S, Alsawas M, Prokop LJ, et al. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. J Vasc Surg. 2018; 68(2):624-33. DOI: 10.1016/j.jvs.2018.01.066. DOI: https://doi.org/10.1016/j.jvs.2018.01.066
8. Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, et al. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022; 387(25):2305-16. DOI: 10.1056/NEJMoa2207899. DOI: https://doi.org/10.1056/NEJMoa2207899
9. Farber A. Chronic Limb-Threatening Ischemia. N Engl J Med. 2018; 379(2):171-80. DOI: 10.1056/NEJMcp1709326. DOI: https://doi.org/10.1056/NEJMcp1709326
10. Ghijsen SC, de la Mar ACJ, Kalsbeek L, van den Heuvel DAF, Bakker OJ. Endovascular Treatment of Patients with Chronic Limb Threatening Ischaemia in an Outpatient Setting. Eur J Vasc Endovasc Surg. 2026; 71(4):703-704. DOI: 10.1016/j.ejvs.2025. 10.053. DOI: https://doi.org/10.1016/j.ejvs.2025.10.053
11. Azuma N. The Diagnostic Classification of Critical Limb Ischemia. Ann Vasc Dis. 2018; 11(4):449-57. DOI: 10.3400/avd.ra.18-00122. DOI: https://doi.org/10.3400/avd.ra.18-00122
12. Croo A, Versyck T, Duinslaeger A, Harth C, Vermassen F, Randon C. The impact of an angiosome-targeted revascularization on healing rate, limb salvage and survival in critical limb threatening ischemia. Acta Chir Belg. 2022; 122(2):107-15. DOI: 10.1080/00015458.2021.1881337. DOI: https://doi.org/10.1080/00015458.2021.1881337
13. Hater H, Halak M, Sunoqrot H, Khaitovich B, Raskin D, Silverberg D. Revascularization of multiple tibial arteries is not associated with improved limb salvage. J Vasc Surg. 2021; 74(1):170-77. DOI: 10.1016/j.jvs.2021.01.026. DOI: https://doi.org/10.1016/j.jvs.2021.01.026
14. Iida O, Urasawa K, Shibata Y, Yamamoto Y, Ando H, Fujihara M, et al. Clinical Safety and Efficacy of Rotational Atherectomy in Japanese Patients with Peripheral Arterial Disease Presenting Femoropopliteal Lesions: The J-SUPREME and J-SUPREME II Trials. J Endovasc Ther. 2022; 29(2):240-47. DOI: 10.1177/ 15266028211045700. DOI: https://doi.org/10.1177/15266028211045700
15. Pecoraro F, Pakeliani D, Bruno S, Dinoto E, Ferlito F, Mirabella D, et al. Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia. J Clin Med. 2021; 10(13):2865. DOI: 10.3390/jcm10132865. DOI: https://doi.org/10.3390/jcm10132865
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