The aim — to analyze the results of the use of endovascular revascularization methods for acute lower limb ischemia (ALLI) caused by thromboses or embolisms of the lower limb arteries.Materials and methods. An evaluation of the results of revascularization with the use of endovascular interventions in 108 patients with ALLI was performed. Depending on the treatment method, patients were divided into two groups. The first group included 78 patients who had intra‑arterial catheter‑directed thrombolysis, the second group included 30 patients after percutaneous aspiration or mechanical thrombectomy. If hemodynamically significant residual stenoses of arteries which caused thrombosis remained after thrombolysis or percutaneous thrombectomy, balloon angioplasty or stenting were used.Results and discussion. Technical success was achieved in 73 % of patients who underwent thrombolysis. Endovascular or surgical interventions in addition to thrombolysis were performed in 45 % of patients. The number of perioperative complications was 27 %, of which hemorrhagic — 14 %, including intracranial hemorrhages — 3 %. The number of larger amputations was 21 %, mortality — 8 %. The technical success of aspiration thrombectomy was 83 %, mechanical thrombectomy — 100 %. In most cases additional endovascular interventions were required to eliminate residual stenoses.Conclusions. Endovascular revascularization is an effective method for the treatment of acute lower limb ischemia. Majority of patients after thrombolysis and percutaneous thrombectomy have residual stenotic lesions of arteries which caused thrombosis and require additional endovascular or surgical treatment.
The aim — to do comparative evaluation of the endovascular and surgical revascularization effectiveness in patients with acute limb ischemia, caused by thrombosis and embolism of lower limb arteries.Materials and methods. The study was performed based on a retrospective analysis of the results of treatment of 215 patients with acute limb ischemia caused by acute emboli and thrombosis of lower limb arteries or bypases. The main group included 108 patients who underwent endovascular interventions (intra‑arterial catheter‑directeded thrombolysis was performed in 72 % of patients, and endovascular thrombectomy was performed in 28 % of patients), the comparison group included 107 patients were performed surgical operations of thromboembolectomy or bypases for the purpose of revascularization.Results and discussion. In order to determine how the degree of ischemia affects technical success of endovascular and surgical interventions in patients with acute limb ischemia, patients were stratified according to severity of ischemia. The technical success of revascularization in patients with 1 or 2A degrees of ischemia was not significantly different between groups. In patients of the surgical group with ischemia 2B, the technical success rate of revascularization was significantly higher compared with endovascular, 83.6 % versus 71.9 % (p < 0.05). The number of amputations in endovascular and surgical groups was not significantly different, 16.7 %, and 18.7 % (p > 0.05).Conclusions. The severity of limb ischemia is the main factor that determines the results of treatment of acute limb ischemia, both with endovascular and surgical methods of revascularization. Patients with severe grade 2B ischemia require emergency restoration of blood circulation in the ischemic limb and surgical methods are the most appropriate treatment. In patients with moderately severe 1 and 2A ischemia, both surgical and endovascular revascularization methods can be effectively used.
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