Single-step endovascular revascularization of the kidney, lower limb and endovascular reconstruction of abdominal aortic aneurysm in a patient with type 2 diabetic mellitus

Dedov I.I., Terekhin S.A., Kalashnikov V.Yu., Mitish V.A., Doronina L.P., Tokmakova A.Yu., Galstyan G.R., Melkozerov K.V., Peretokina E.V.

Interventional Cardiology Department State Federal Facility Endocrinological Scientific Centre under the Russian Federation Ministry of Public Health and Social Development, Moscow, Russia

Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the develop¬ment of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm. The com¬prehensive treatment of the patient resulted in safe performance of the endovascular intervention, saving the supporting function of the limb, improvement of glycemic control, decreasing the risk of sudden death on the background of abdominal aortic aneurysm rupture, decreased rate of progression of renal insufficiency, better control of symptoms of angina pectoris and cardiac failure. Also the article reflects importance of rendering medical care for patients with multifocal atherosclerosis and diabetes mellitus, also showing the necessity of creating multi-modality medical centres and working out of algorithms for treatment of this patient cohort.

KEY WORDS: diabetes mellitus, limb critical ischaemia, peripheral atherosclerosis, renal arteries stenosis, abdominal aortic aneurysm, balloon angioplasty with stenting, endovascular prosthetic repair of abdominal aortic aneurysm.

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