gms | German Medical Science

Background: Importance: 200 million patients worldwide have peripheral artery disease. The most severe manifestation of this disease is critical limb ischemia, which is associated with the highest incidence of disability and mortality from major cardiovascular events. The United States estimates that more than $ 4 billion is spent annually on critical limb ischemia. Although there are many treatments, the revascularization strategy and the feasibility of endovascular correction remain controversial.

The aim of the study was to analyze the results of endovascular correction in patients with critical lower extremity ischemia.

Methods: In the period from September 24, 2019 to May 25, 2021, 36 patients with critical limb ischemia were treated by endovascular correction on the iliac artery and arteries below the inguinal ligament. The study involved: 31 (86.1%) men and 5 (13.9%) women. The average age was: 62.1 + 6.8 years. The active duration of the disease was 2.2 + 0.7 years. Eight patients (22.2%) suffered from diabetes mellitus. We performed CT scans on 14 patients before the operation, and ultrasound on another (22 patients). Surgical interventions were performed on an angiograph Infinix-I (Canon Medical System) and on INFX-8000V INFINIX VF-i / SP (Toshiba Medical Systems Corporation). The technique of the operation was cross access to the femoral artery in a group of 11 patients, and in the second group of 25 patients – antegrade access. We never performed balloon angioplasty of the iliac segment before stenting, we used only balloon-expandable stents (Neptune, Balton). If the localization of stenosis in the femoral artery, we performed balloon angioplasty, after it was performed angiography on to address the issue that the need stenting or not. For the femoral artery, we used self-expanding stents (Jaguar, Balton). For the tibial arteries, we performed only balloon angioplasty. Further examinations were every 3, 6 and 12 months.

Results: In all cases, we had a positive result, which included improved life and complete wound healing.

In 22 cases, stent artery stenting was performed using self-expanding stents and in 10 patients we used only balloon angioplasty with good results. 12 patients had occlusion of the tibial artery, they underwent only balloon angioplasty without stenting. During the follow-up period (within 12 months), repeated intervention was necessary in 6 cases. In 4 patients, we performed stenting of the femoral artery, which was initially performed balloon angioplasty. In 1 case there was restenosis in the distal part of the stent and in 1 other case there was a stent thrombosis.

Conclusions:

1.

Endovascular treatment of critical lower extremity ischemia is an effective treatment.

2.

Upon receipt of a positive result of balloon angioplasty of the femoral artery should refrain from "premature" stenting.

3.

In our opinion, ASA + Rivoroxaban 2.5 twice a day is a safe and good combination for the prevention of thrombosis in the postoperative period.