Staged and hybrid surgical treatment of patients with critical lower limb ischemia in multilevel lesions

• Mikhaylov I.P.
• Kokov L.S.
• Eroshkin I.A.
• Kozlovskiy B.V.

Abstract

Objective. The purpose of this study was to assess efficacy of staged operations in patients presenting with lower limb critical ischemia caused by multilevel lesions of lower limb arteries.

Patients and methods. Our study enrolled a total of 56 patients with critical lower limb ischemia, including 40 (71.4%) men and 16 (28.6%) women, mean age 68±7.9 years. 33 (58.9%) patients had trophic disorders. All patients underwent open surgical and endovascular treatment: 36 patients (Group I) were subjected to staged surgery and the remaining 20 (Group II) to hybrid operations. Staged interventions were performed at various hospital admissions, with the intervals between them amounting to 4–25 days. These stages were performed in separate operating rooms. Hybrid operations were carried out in an elective vascular surgery ward equipped with a C-arm. The duration of follow-up amounted to 12 months.

Results. The mean duration of open surgical operations was 112±74.7 min, with that of endovascular stages and of simultaneous hybrid interventions amounting to 130.4±80.2 min and 212±56 min, respectively Primary patency of the reconstructed zones during 12 months was preserved in 32 (88.9%) Group I patients. Four (11.1%) patients of this group developed thrombosis of the reconstructed zone in the remote period and one (2.8%) – ischemic gangrene. Primary patency at 12 months was preserved in 18 (90.0%) Group II patients, with improvement of lower limb blood supply. Two (10.0%) patients developed thrombosis of the reconstruction zone. There were neither amputations nor lethal outcomes in the group of hybrid operations.

Conclusion. The division of open and endovascular stages appeared to be an admissible method of surgical treatment of patients with lower limb critical ischemia and by primary patency, limb salvage and survival rates proved not inferior to hybrid operations.

Keywords:lower limb critical ischemia; multilevel lesion; hybrid operations; staged operations; surgical treatment

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