The importance of use of endovascular methods in the provision of medical care to patients with critical limb ischemia

Abstract

This paper contains general information concerning angiosurgeons activity of St. Petersburg regional vascular centers at the period from 2011 to 2015. In particular specialists’ activities assessment obtained by modeling of municipal multi-field hospitals medical assistance are provided for 403 patients with critical limb ischemia. All the patients’ arterial beds were affected by atherosclerosis. Open reconstruction of arteries was performed for 278 patients, endovascular revascularization — for 51, and 15 patients underwent hybrid surgery. In 55 cases it was decided to abstain from the revascularization. In case of open surgical services endarterectomy loop formed by aortoiliac and femoropopliteal segments (190) as well as shunting arterial reconstructions (45) prevailed. In case of endoarterial treatment vascular correction was performed in femoropopliteal tibial segments (37 observations). In cases of refusal to reconstruct the arteries, amputation of lower limbs (15) and lumbar sympathectomy (14) was performed. Angiotropic therapy took place in 30 cases. In the early postoperative period, the complications of open surgical treatment were detected in 21.6 % of cases; complications of endovascular surgical treatment — in 15 % and complications of hybrid surgical treatment — in 13.3 % of cases. Among the complications, the vascular thrombosis in the area of their reconstruction (35 %) and the lack of blood supply to the limbs tissues in permeate vessels (19.7 %) prevailed. No fatal cases were observed. In general, the use of endovascular and hybrid reconstructions of the vascular bed at the specialized divisions of medical organizations for patients with critical limb ischemia and multifocal atherosclerosis justifies itself.