[Revascularization of lower limbs in patients with critical ischaemia induced by lesions of infrainguinal arteries]

Abstract

Aim: The study was aimed at comparative analysis of efficacy of endovascular and surgical revascularization in patients presenting with lower limb critical ischaemia (LLCI) due to lesions of infrainguinal arteries.

Material and methods: The retrospective study included a total of 236 patients with LLCI undergoing revascularization of lower extremities performed at our Institute from 2007 to 2011. The patients were subdivided into two groups. Group One consisted of 135 patients subjected to transcutaneous endovascular interventions. Group Two comprised a total of 101 patients having endured bypass grafting operations. Limb salvage and survival of patients during five years were assessed by means of the Kaplan-Meyer method.

Results: Technical success and clinical improvement in the both groups did not differ significantly, amounting to 90%. The complication rate and the number of major amputations turned out considerably higher in the group of surgical treatment as compared with that in the group of endovascular treatment. After 1, 3 and 5 years the indices of limb salvage and survival (LSS) in the both groups did not differ significantly amounting respectively to 94.4, 72.7, and 52.2% in the surgical group and 89.7, 67.2 and 46.3% in the endovascular group (p=0.196). The number or re-do operations in the remote period due to relapses of LLCI was considerably higher in the group of endovascular treatment.

Conclusion: Endovascular and surgical methods demonstrate similar immediate and remote outcomes in patients with LLCI induced by lesions of infrainguinal arteries, but the choice of the method of revascularization should obligatorily take into consideration the localization and extension of arterial lesions, the presence of an appropriate autovein for the bypass graft, the level of perioperative risk, and life expectancy.