Outcomes of surgical revascularization in patients after stenting of lower-limb arteries

Gavrilenko A.V.^1,2, Kotov A.E.¹, Shatalova D.V.²

1) Vascular Surgery Department, B.V. Petrovsky Russian Research Centre of Surgery under the Russian Academy of Medical Sciences,
2) Chair of Cardiovascular Surgery No1 First Moscow State Medical University named after I.M. Sechenov, Moscow, Russia

The authors analysed immediate and remote results of primary "open" reconstructive operations and arterial reconstructions performed after previous stenting of lower-limb arteries. The study comprised a total of 93 patients presenting with lower-limb critical ischaemia. Group One consisted of 46 patients with localization of the lesion of lower-limb arteries above the inguinal ligament. Group Two was composed of 47 patients with localization of lower-limb arteries lesions below the inguinal ligament. Each group was subdivided into two subgroups: subgroups Ia and IIa included patients with previously endured stenting of arteries of the respective segment (23 and 22 patients, respectively), subgroups Ib and IIb included patients previously not subjected to either endovascular or surgical treatment (23 and 25 patients, respectively). All patients underwent "open" reconstructive vascular operations. The outcomes of intervention were assessed at the hospital stage, as well as at 6, 12 and 36 months of consecutive follow up.

After 8 months of follow up patency of the shunts in all patients amounted to 100%, with the lower-limb salvage rate of 100%. After 1 year, despite differences between subgroups in each group, they were not statistically significant (p>0.05). After 3 years differences in shunts’ patency and lower limb salvage rate in subgroups IIa and IIb were statistically significant (p<0.05). By the increment of the ankle-brachial index, the best result after 3 years was achieved in patients with primary arterial reconstruction (subgroups Ib and IIb) as compared to patients with previously endured endovascular interventions. The conclusion was drawn that shunts patency, limb salvage rate and increment of the ankle-brachial index in the remote period after performing primary arterial reconstructions below the Poupart's ligament were better than in patients with previously endured endovascular interventions.

KEY WORDS: lower limb critical ischaemia, endovascular interventions, reconstructive operations, redo operations, stenting.

P. 169

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