Early or delayed revascularization in patients with peripheral arterial disease: how to make the right choice?

Peripheral artery bypass surgery can be performed both in patients at the stage of claudication or in those who is suffering from critical limb ischemia (CLI). Patients with CLI have more severe stages of atherosclerosis and comorbidities as compared with patients at the stage of claudication, and tend to have a higher risk of amputation and death following revascularization of the lower limb. No comparison of primary surgery outcomes performed at the stages of claudication and CLI has been conducted so far. This study was based on different approaches to timing and techniques of peripheral artery bypass surgery and aimed at studying the results of revascularization procedures performed in patients with various stages of chronic lower limb ischemia.Materials and methods. The study included 88 patients who had undergone surgical revascularization. In 44 cases, the surgical procedures were performed at the CLI stage and 44 cases - at the stage of claudication. Similar techniques of revascularization were used in both groups, including conventional (bypass surgery, endarterectomy) and endovascular procedures (angioplasty or stenting). The outcomes of revascularization procedures were evaluated within the first 30 days after the surgery.Results. Clinical improvement after the surgery was more commonly observed in the claudication group (93%) compared with the CLI group (75%). The rate of complications in the CLI group (59%) was in 5 times more that in the claudication group (9%).Conclusions. Timely performed surgical revascularization for limb ischemia in patients with rapidly progressing peripheral arterial disease can contribute to lower rate of complications and amputations and better clinical outcomes