Efficacy evaluation of surgical treatment of critical limb ischemia with atherosclerotic arterial disease

The objective of the paper is to study the characteristics of circulatory disorders and necrotic foci with critical limb ischemia on the background of atherosclerotic arterial involvement and to evaluate the short-term results of critical lower limb ischemia (CLLI) surgical treatment. Materials and Methods. The features of circulatory disorders and necrotic foci with CLLI on the background of atherosclerotic arterial involvement were studied in 80 patients. The male to female ratio was 6:1. All patients demonstrated CLLI signs upon admission to hospital, i.e. rest pain, focal necrosis. Surgical blood flow recovery of the lower limbs was conducted, the short-term results were assessed. Results. In most cases the preoperative color duplex scanning and abdominal aortography with lower limb angiography revealed superficial femoral artery lesion (95 %) and the popliteal artery lesion (72.75 %). Stenoses and occlusive processes in iliac arteries were found only in one third of patients (35.75 %). Occlusion of the superficial femoral artery was recorded much more often than that of the peroneal artery (71.25 % and 47.5 % respectively, p=0.00). 35 % of patients with atherosclerosis demonstrated the involvement of the foot arteries. Operative treatment included surgical repair of the affected limb arteries and the elimination of purulonecrotic focus, which was conducted simultaneously with reconstructive vascular surgery (40 patients), and in incremental steps (before and/or after revascularization) (40 patients). Conclusion. Multilevel arterial involvement with changes in the femoral, popliteal, and tibial segments and coagulation necrosis of the 2-4th toes was detected in 50 % of cases. Revascularization of femoral, popliteal and tibial segments with vein grafts, venous or arterial allografts, and synthetic prostheses allowed us to restore blood flow effectively in the early postoperative stage in 96.25 % of cases and in 97.50 % of cases to avoid limb amputation. The sequence of revascularization and purulonecrotic focus debridement on the foot and lower limb did not affect the duration of ulcerous defect repair.