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3 . 2021

Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with lesions of the femoral-poplitealtibial arterial segment

Abstract

Background. An increase in the incidence rate of atherosclerosis obliterans of the arteries of the lower extremities among patients with diabetes mellitus and the peculiarities of vascular lesions in this category of patients make it necessary to search for the most optimal tactics of surgical treatment to preserve the limb during the development of critical ischemia.

Aims - to increase the effectiveness of treatment of patients with critical ischemia of the lower extremities of atherosclerotic genesis against the background of diabetes in the near and long term. Material and methods. The study, conducted on the basis of clinical hospitals in the city of Volgograd from 2012 to 2019, included 61 patients with occlusive-stenotic lesions of the arteries of the femoral-poplitealtibial segment of the lower extremities III-IV stages according to Fontaine-Pokrovsky and diabetes mellitus revascularizing interventions. The study participants were divided into two groups depending on the tactics of surgical treatment undertaken. Patients of the 1st group (n=35) underwent only endovasal revascularization, patients of the 2nd (n=26) group underwent hybrid operations combining open reconstruction and transluminal balloon angioplasty. In the postoperative period, the patients underwent conservative therapy and continued dynamic observation. 

Results. Over the entire observation period, patients of the 1st group underwent 21 repeated interventions (60% of the number of primary operations), of which 16 (45.7%) were performed on the limbs revascularized when patients were included in the study, participants of the 2nd group underwent 13 (50.0%) and 11 (42.3%) interventions respectively. 3 (8.6%) patients of the 1st group and 2 (7.7%) patients of the 2nd group required a large amputation at the level of the thigh or lower leg. Small amputations were performed in 17 (48.6%) study participants from the 1st group, 13 (50.0%) from the 2nd. The mortality rate in the two groups also did not have statistically significant differences. 

Conclusions. For patients with critical lower limb ischemia and diabetes mellitus, both isolated endovasal revascularization and a hybrid nature of the intervention can be recommended. Strict dispensary observation of this category of patients is necessary, including an assessment of the clinical status of the lower extremities and the correction of the prescribed pathogenetic therapy.

Keywords:diabetes mellitus, critical lower limb ischemia, hybrid interventions, endovascular surgery

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Frolov D.V., Mozgovoy P.V., Linchenko D.V., Frolov M.V., Chernovolenko A.A., Dyachkova Yu.A., Obuhov A.D. Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with lesions of the femoral-popliteal-tibial arterial segment. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (3): 104-11. DOI: https://doi.org/10.33029/2308-1198-2021-9-3-104-111 (in Russian)

References

1. Zudin A.M., Zasorina M.A., Orlova M.A. Epidemiology of chronic critical limb ischemia. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal Named after N.I. Pirogov]. 2014; (10): 78–82. (in Russian).

2. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II), 2007.

3. Kharazov A.F., Kalyev A.O., Isaev A.A. PAD prevalence in Russian Federation. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal Named after N.I. Pirogov]. 2016; (7): 58–61. DOI: https://doi.org/10.17116/hirurgia2016758-61  (in Russian)

4. Gavrilenko A.V., Kotov A.E., Kochetov S.V. Surgical treatment of patients with critical lower limb ischemia IV degree. Annaly khirurgii [Annals of Surgery]. 2010; (3): 5–7 (in Russian).

5. Bensman VM, Triandafi lov KG. Debatable questions in diabetic foot syndrome classifi cation. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal Named after N.I. Pirogov]. 2009; (4): 37–41. (in Russian)

6. Dibirov M.D., Dibirov A.A., Gadzhimuradov R.U., et al. Distal reconstructions under critical lower limb ischemia in elderly patients. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal Named after N.I. Pirogov]. 2009; (1): 49–52. (in Russian).

7.    Baumann F., Engelberger R.P., Willenberg T., et al. Infrapopliteal lesion morphology in patients with critical limb ischemia: implications for the development of anti-restenosis technologies. J Endovasc Ther. 2013; 20 (2): 149-56. DOI: https://doi.org/10.1583/1545-1550-20.2.149

8.    Kristensen S.D., Knuuti J., Saraste A., et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014; 35 (35): 2383-431. DOI: https://doi.org/10.1093/eurheartj/ehu282

9. Kazakov Yu.I., Lukin I.B., Velikov    P.G., Strakhov M.A. The choice of reconstruction technique of infrainguinal arterial segment in patients with chronic critical limb ischemia. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2014; 7 (6): 42-8. (in Russian).

10.    Bondarenko O.N., Galstyan G.R., Dedov I.I. The clinical course of critical limb ischaemia and the role of endovascular revascularisation in patients with diabetes. Sakharniy diabet [Diabetes Mellitus]. 2015; 18 (3): 57-69. DOI: https://doi.org/10.14341/DM2015357-69 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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