Results of Using Endovascular Technologies for Removal of Critical Lower Limb Ischemia in Patients of Regional Vascular Centres Located at Multidisciplinary Hospitals

Abstract

The aim of the study was to evaluate the outcomes of health care in the setting of a regional vascular centre of a multidisciplinary hospital in patients with critical lower limb ischemia based on the data of preoperative arterial hypertension of the leg circulatory bed. Materials and methods. General data on the organisational effectiveness of regional vascular centres in the second largest Russian city, Saint Petersburg, were analysed. The work of a large multidisciplinary medical organisation of the city, City Multidisciplinary Hospital No. 2, was studied in detail, whose regional vascular centre examined and treated 295 men and 88 women with pathology of the lower limb arteries in 2013-2015. The patients underwent the following surgeries: open vascular reconstruction-282, endovascular revascularisation-47, and hybrid surgical interventions were performed in 15 patients. In 55 cases, lower limb revascularisation was refused due to lack of opportunities for vascular bed reconstruction or because of irreversible changes in the tissues of the lower limbs. Results. Application of the options of lower limb artery angiography preoperatively allowed to reliably estimate the degree of damage to the vascular bed, and make a reasoned choice between leg artery revascularisation methods. This technique proved to be most effective in patients with critical lower limb ischemia with severe comorbidity. Overall, the incidence of complications of open surgical interventions in vascular bed in the early postoperative period was 21.6%, and of endovascular and hybrid surgeries-15% and 13.3%, respectively. No cases of deaths were reported. Conclusions. Endovascular and hybrid surgical interventions in obliterating diseases of the lower limb arteries provides a significant reduction in the incidence of intra-and postoperative complications in patients with multifocal atherosclerosis, and their combination with the use of less traumatic "open" surgical interventions (semiclosed loop endarterectomy) offers new opportunities in the therapy of patients with critical lower limb ischemia.