Ways of decreasing incidence of complications in patients after endured reconstructive and endovascular operations on lower limb arteries

Arakelyan V.S.

National Medical Research Centre of Cardiovascular Surgery named after A.N. Bakulev under the RF Ministry of Public Health, Moscow, Russia

Peripheral artery disease represented predominantly by atherosclerosis obliterans is a common social burden all over the world. The main method of treatment for peripheral artery disease (PAD) is considered to be open surgical or endovascular revascularization. Unfortunately, despite a steadily growing number of operations and implementation of new types of interventions, including endovascular ones, the prognosis in patients with peripheral artery diseases still remains unfavourable. Moreover, patients having endured revascularization are susceptible to especially high risk of subsequent ischaemic complications from the side of both the cardiovascular system as a whole (strokes, infarctions, cardiovascular death) and the limb in the form of progressing ischaemia, development of critical and/or acute ischaemia. All the above mentioned determines the necessity of carrying out intensive accompanying medicamentous therapy. At the same time, the contemporary literature contains contradictory results of using different drugs in order to decrease the risk for progression of lower limb ischaemia, as well as the incidence of adverse cardiovascular events in the form of strokes, infarctions, and cardiovascular death. Disputable remains the question of whether monotherapy with acetylsalicylic acid still remains the only well evidence-based method of treatment in randomized multiple-centre studies. There are various opinions on the place of dual anticoagulant and antiplatelet therapy in treatment of PAD. The findings of the multi-centre randomized COMPASS trial published in 2018 significantly altered the approaches to medicamentous therapy of this patient cohort.

The purpose of our study was to carry out a systematic review of literature, making it possible to assess the risks and prognosis in patients presenting with peripheral artery disease after a vascular intervention, as well as to determine therapy capable of improving the outcomes of surgical treatment.

KEY WORDS: atherosclerosis of lower limb arteries, revascularization of lower limb arteries, lower extremity amputation, repeat operations on lower limb arteries, antiplatelet therapy, rivaroxaban.

P. 173

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