Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries

Keywords: atherosclerosis obliterans, revascularization, balloon angioplasty, endovascular intervention, critical limb ischemia

Abstract

Peripheral artery diseases are a worldwide medical and social problem. Approximately 30 % of patients with critical limb ischemia will undergo amputations and 25 % will die after 1 year. These patients require reconstructive and angioplastic interventions to preserve the limb.

The aim of the study is to compare the effectiveness of different endovascular surgical technologies in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries.

Materials and methods. Among 243 endovascular interventions, 51 patients were presented with multilevel steno-occlusive lesions of the infrarenal aortic arteries as a result of atherosclerosis obliterans. 42 patients (82.4 %) had two-level lesions and 9 (17.6 %) had three-level lesions.

Results. Among 42 patients with a two-level lesion, 29 (56.9 %) ones had femoral arterial segment affection in combination with tibial artery affection. 13 (25.5 %) patients suffered from the lesion of the iliac segment in combination with the affection of the femoral segment arteries. In 9 (17.6 %) patients the lesions of three or more levels were determined: an iliac segment in combination with femoral and popliteal arteries – in 4 patients, and in 2 patients there were lesions of the femoral, popliteal and tibial segments, in 3 patients there was a lesion of the iliac, femoral, popliteal and tibial-foot segments in different degrees of severity.

7 balloon angioplasties and 13 stenting procedures were performed in two and three-level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used to revascularize the infraingvinal arterial segments. In the early postoperative period, the complications included thrombosis appeared in 6 patients. It was possible to restore the blood flow and save the limb only in 3 persons. For the other 3 ones, the attempts to restore the patency of the arteries were unsuccessful and resulted in the amputation of the lower extremity. Mortality in the early postoperative period was 3.9 % (2 death due to myocardial infarction).

Conclusions. The persons with multilevel steno-obstructive lesions of the infrarenal aortic arteries are the most difficult category of patients with CLI. The surgical method of choice for patients with multilevel steno-occlusive lesions is the endovascular angioplasty with or without stenting.

Downloads

Download data is not yet available.

Author Biographies

Volodymyr Shaprynskyi, National Pirogov Memorial Medical University

Department of Surgery No. 1

Vasylysa Suleimanova, National Pirogov Memorial Medical University

Department of Surgery No. 1

References

Fowkes, F. G. R., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J. O., McDermott, M. M. et. al. (2013). Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. The Lancet, 382 (9901), 1329–1340. doi: http://doi.org/10.1016/s0140-6736(13)61249-0

Almasri, J., Adusumalli, J., Asi, N., Lakis, S., Alsawas, M., Prokop, L. J. et. al. (2018). A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. Journal of Vascular Surgery, 68 (2), 624–633. doi: http://doi.org/10.1016/j.jvs.2018.01.066

Norgren, L., Hiatt, W. R., Dormandy, J. A., Nehler, M. R., Harris, K. A., Fowkes, F. G. R. (2007). Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European Journal of Vascular and Endovascular Surgery, 33 (1), S1–S75. doi: http://doi.org/10.1016/j.ejvs.2006.09.024

Criqui, M. H., Aboyans, V. (2015). Epidemiology of Peripheral Artery Disease. Circulation Research, 116 (9), 1509–1526. doi: http://doi.org/10.1161/circresaha.116.303849

Catalano, M. (1993). Epidemiology of critical limb ischaemia: north Italian data. The European journal of medicine, 2 (1), 11–14.

Kröger, K., Stang, A., Kondratieva, J., Moebus, S., Beck, E. et. al. (2006). Prevalence of Peripheral Arterial Disease – Results of the Heinz Nixdorf Recall Study. European Journal of Epidemiology, 21 (4), 279–285. doi: http://doi.org/10.1007/s10654-006-0015-9

Teraa, M., Conte, M. S., Moll, F. L., Verhaar, M. C. (2016). Critical Limb Ischemia: Current Trends and Future Directions. Journal of the American Heart Association, 5 (2). doi: http://doi.org/10.1161/jaha.115.002938

Schürch, K. A., Sixt, S., Jeanneret, C., Canova, C. R. (2018). Update über die aktuelle Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK). Therapeutische Umschau, 75 (8), 478–488. doi: http://doi.org/10.1024/0040-5930/a001028

Zeller, T., Baumgartner, I., Scheinert, D., Brodmann, M., Bosiers, M., Micari, A. et. al. (2014). Drug-Eluting Balloon Versus Standard Balloon Angioplasty for Infrapopliteal Arterial Revascularization in Critical Limb Ischemia: 12-Month Results From the IN.PACT DEEP Randomized Trial. Journal of the American College of Cardiology, 64 (15), 1568–1576. doi: http://doi.org/10.1016/j.jacc.2014.06.1198

Menard, M. T., Farber, A. (2014). The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for patients with critical limb ischemia. Seminars in Vascular Surgery, 27 (1), 82–84. doi: http://doi.org/10.1053/j.semvascsurg.2015.01.003

Dinoto, E., Pecoraro, F., Cutrupi, A., Bracale, U. M., Panagrosso, M., Bajardi, G. (2020). Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease. International Journal of Surgery Case Reports, 77, S166–S169. doi: http://doi.org/10.1016/j.ijscr.2020.09.018

Dominguez, A., Bahadorani, J., Reeves, R., Mahmud, E., Patel, M. (2015). Endovascular therapy for critical limb ischemia. Expert Review of Cardiovascular Therapy, 13 (4), 429–444. doi: http://doi.org/10.1586/14779072.2015.1019472

Laird, J. R., Katzen, B. T., Scheinert, D., Lammer, J., Carpenter, J., Buchbinder, M. et. al. (2012). Nitinol Stent Implantation vs. Balloon Angioplasty for Lesions in the Superficial Femoral and Proximal Popliteal Arteries of Patients With Claudication: Three-Year Follow-up From the RESILIENT Randomized Trial. Journal of Endovascular Therapy, 19 (1), 1–9. doi: http://doi.org/10.1583/11-3627.1

Jens, S., Conijn, A. P., Koelemay, M. J. W., Bipat, S., Reekers, J. A. (2014). Randomized Trials for Endovascular Treatment of Infrainguinal Arterial Disease: Systematic Review and Meta-analysis (Part 2: Below the Knee). European Journal of Vascular and Endovascular Surgery, 47 (5), 536–544. doi: http://doi.org/10.1016/j.ejvs.2014.02.012

Tepe, G., Laird, J., Schneider, P., Brodmann, M., Krishnan, P., Micari, A. et. al. (2015). Drug-Coated Balloon Versus Standard Percutaneous Transluminal Angioplasty for the Treatment of Superficial Femoral and Popliteal Peripheral Artery Disease. Circulation, 131 (5), 495–502. doi: http://doi.org/10.1161/circulationaha.114.011004

Bradbury, A. W., Adam, D. J., Bell, J., Forbes, J. F., Fowkes, F. G. R., Gillespie, I. et. al. (2010). Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making. Journal of Vascular Surgery, 51 (5), 52S–68S. doi: http://doi.org/10.1016/j.jvs.2010.01.077

Abu Dabrh, A. M., Steffen, M. W., Undavalli, C., Asi, N., Wang, Z., Elamin, M. B. et. al. (2015). The natural history of untreated severe or critical limb ischemia. Journal of Vascular Surgery, 62 (6), 1642–1651.e3. doi: http://doi.org/10.1016/j.jvs.2015.07.065

Amann-Vesti, B. (2013). Scores und Stadien für die Praxis – Angiologie. Therapeutische Umschau, 70 (10), 567–571. doi: http://doi.org/10.1024/0040-5930/a000448

Rosenfield, K., Jaff, M. R., White, C. J., Rocha-Singh, K., Mena-Hurtado, C., Metzger, D. C. et. al. (2015). Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease. New England Journal of Medicine, 373 (2), 145–153. doi: http://doi.org/10.1056/nejmoa1406235

Hiramatsu K. (1983). Rinsho hoshasen. Clinical radiography, 28 (11 Suppl), 1127–1135.


👁 56
⬇ 46
Published
2021-11-30
How to Cite
Shaprynskyi, V., Shaprynskyi, V., & Suleimanova, V. (2021). Endovascular interventions in patients with multilevel steno-occlusive lesions of the infrarenal aortic arteries. EUREKA: Health Sciences, (6), 24-29. https://doi.org/10.21303/2504-5679.2021.002193
Section
Medicine and Dentistry