Is reconstruction justified at the claudication stage in a patient with peripheral atherosclerosis?

Rationale: The possibility of surgical intervention in patients with claudication determines the direction of treatment. At the same time, some patients are not characterized by a benign course of peripheral arterial disease. This work is based on clarifying the results of reconstructive treatment of patients with PAD at the stage of critical ischemia and in the case of stage IIb according to Pokrovsky — Fontaine. Objective: analyze early postoperative complications and find an answer to the question: “Is stage IIb reconstruction justified in patients with PAD?” Method: The study involved 237 patients who underwent reconstructive interventions for peripheral arterial disease. Of these, 136 patients were operated on at the CLI stage (critical limb ischemia — critical ischemia), and 101 patients received surgical assistance at the stage of claudication. The results of surgical interventions were prospectively assessed during the first 30 days after surgery and retrospectively analyzed. The primary end point was the development of complications (segment thrombosis, bleeding, surgical site infection). Results: Patients treated surgically for stage CLI were more likely to experience early postoperative complications (thrombosis, infection, bleeding, and amputation). This is probably due to the more significant degree of arterial damage (multi-level damage) and the choice of surgical interventions. Conclusion: The group of patients operated on at the stage of critical ischemia had a greater number of complications, therefore, in the case of an unfavorable development with a pronounced reduction in walking distance, the focus of tactical approaches should be changed towards active tactics, without waiting for the development of critical ischemia.