Results of Surgical Treatment of Patients with Critical Limb Ischemia and Stenotic Lesions of the Brachiocephalic Arteries
¹Institute of Medicine, Ecology and Physical Education of Ulyanovsk State University; ²Ulyanovsk Regional Hospital. Ulyanovsk, The Russian Federation
*Corresponding author: Prof. Alexei L. Charyshkin, PhD, ScD. Head of the Faculty Surgery Department, Institute of Medicine, Ecology and Physical Education, Ulyanovsk State University. Ulyanovsk, The Russian Federation. E-mail: firstname.lastname@example.org
Published: June 16, 2017. doi: 10.21103/Article7(2)_ShC2
The aim of our study was to evaluate the results of the surgical treatment for patients with critical limb ischemia (CLI) and stenotic lesions of the brachiocephalic arteries.
Methods and Results: We examined 72 patients (68/87.2% men and 4/7.3% women) aged from 46 to 78 years (mean age, 62.2±4.3 years) with CLI and stenotic lesions of the brachiocephalic arteries. Conservative treatment was performed in 17(23.6%) patients and surgical treatment in 55(76.4%). It has been carried out 73 surgical operations: femoral popliteal bypass (5/6.8%), lumbar sympathectomy (4/5.5%), thrombectomy of occluded aortofemoral graft (2/2.7%), limb amputation (4/5.5%), iliofemoral bypass (4/5.5%), aortofemoral bifurcation bypass (10/13.1%), endovascular surgery (1/1.6%), limb amputation at thigh level - 4(5.5%), thrombectomy of occluded distal arteries (4/5.5%), femoro-femoral cross-over bypass (1/1.6%), resection of popliteal artery aneurysm and prosthesis of the popliteal artery (1/1.6%), semi-closed loop endarterectomy of occluded arteries of the lower limbs (8/10.9%), carotid endarterectomy (23/31.5%), and carotid-subclavian bypass (2/2.7%). After the surgical intervention, we observed the disappearance or reduction of pain, restoration of sensitivity and motor activity, and healing of trophic ulcers in 75% of patients. In the late postoperative period, we detected the progression of limb ischemia in 4(5.5%) patients; in connection with that, we performed limb amputation at thigh level. Ischemic stroke with a lethal outcome developed in one patient (1.4%).
Conclusion: In patients with multifocal atherosclerosis, multilevel reconstructive surgical interventions must be performed in stages, due to the high operational risk, and risk of complications, secondary amputations and lethality in the postoperative period.
- Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PW. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J. 2002;143:961–965.
- Teraa M1, Conte MS2, Moll FL3, Verhaar MC4. Critical Limb Ischemia: Current Trends and Future Directions. J Am Heart Assoc. 2016 Feb 23;5(2). pii: e002938. doi: 10.1161/JAHA.115.002938.
- Abalmasov KG, Buziashvili II, Morozov KM. Quality of life of patients with chronic ischemia of the lower limbs. Angology and Vascular Surgery (Moscow). 2004; 10(2):8–13.
- Gavrilenko AV. Assessment of quality of life in patients with critical ischemia of the lower limbs. Angology and Vascular Surgery (M0scow). 2001;7(3): 8–14.
- Galstyan GE. Algorithm for diagnosis and treatment of the peripheral artery disease. Consilium medicum. 2006;8(12):34–8.
- Katelnitsky I.I. Opportunities of operative treatment of geriatric patients with critical ischemia of the lower limbs // Uspekhi gerontologii. 2012;25(3):338-42.
- Shevchenko Yu. L. Medico-biological and physiological basis of cellular technologies in cardiovascular surgery. SPb.: Nauka; 2006.
- Dominguez LJ, Barbagallo M, Sowers JR, Resnick LM. Magnesium responsiveness to insulin and insulin-like growth factor I in erythrocytes from normotensive and hypertensive subjects. J Clin Endocr Metab. 1998; 83(12):4402–7.
- Ruth SoRelle. Dilemma of Angiogenesis. Circulation. 2000;101:e23-e24
- Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. Vasc Surg. 1997;26(3):516–38.
- Sandberg T, Ehinger A, Casslén B. Paracrine stimulation of capillary cell migration tissue involves epidermal growth factor and is mediated via
urokinase plasminogen activator receptor. J Clin Endocr Metab.
- Shintani S, Murohara T, Ikeda H, Ueno T, Sasaki K, Duan J, Imaizumi T. Augmentation of postnatal neovascularization with autologous bone marrow transplantation. Circulation. 2001;103(6):897-903.
- Simons M. Angiogenesis: where do we stand now? Circulation. 2005;111(12):1556–66.
The fully formatted PDF version is available.
International Journal of Biomedicine. 2017;7(2):147-149. ©2017 International Medical Research and Development Corporation. All rights reserved.