Endovascular Approach in Treatment of Critical Lower Limb Ischemia

Simon Papoyan ¹, Alexandr Schegolev ², Dmitry Gromov ¹, Maxim Sazonov ¹

¹ Inozemtcev Moscow Municipal Hospital, Moscow, Russia; ² Pirogov National Research Medical University, Moscow, Russia;

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: To show effectiveness of endovascular procedures in patients with critical lower limb ischemia.

Materials and Methods: From March 2013 to June 2017 68 patients with  arterial occlusive disease underwent 81 endovascular procedures.. The mean age was 68 years. Most patients were male (88,2%).  26 patients had persistent rest pain and 42 patients had minor tissue loss. Iliac lesions were defined according to the TASC II Type A 7 patients, type B 4 patients, typeС 2 patients type D 12 patients.  PTA/stent procedure .  Selective angiography was performed with the patient under local anesthesia through a contralateral, retrograde, or ipsilateral antegrade common femoral artery approach using 6F or 7F sheaths.  Lesionswere crossed with platinum-tipped (0.018, 0.014) or hydrophilic wires (0.035, 0.018, 0.014) and balloon angioplasty was performed under systemic anticoagulation. Subintimal angioplasty was used to traverse occluded SFA lesions in 5 cases. Balloon catheter diameter was chosen to match the nondiseased artery adjacent to the lesion. A selective approach to the use of Nitinol self-expanding stents was used for flow-limiting dissections or when angioplasty alone did not produce a satisfactory result, for SFA. For Illiac lesions always used stents. Postprocedure, all patients were given a loading dose of clopidogrel (300 mg) and maintained on 75 mg per day for 12 weeks. Patients also received 325 mg of aspirin on the day of the procedure.  Results: primary technical success in group with A, B, C TASC II aortoiliac lesions was 100%, with D TASC II aortoiliac lesions was 91,7%. In group with infrainguinal lesions overall primary technical success was 91,9%. Regression of ischemia was marked in all patients.  During one year follow-up period 3 major amputations were performed (5,8% of follow-up patients), all in cases of above knee interventions with one recanalized tibial artery. Limb salvage rate was 94,2% .