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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
[Assessment of surgical risk in patients with lower limb chronic critical ischaemia]
Iu I Kazakov1, I B Lukin1, N Iu Sokolova2
1Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation, Tver, Russia; Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia.
Insights
A new surgical risk scale helps predict survival for critical limb ischemia patients undergoing arterial reconstruction. Lower risk scores correlate with better outcomes, guiding treatment choices between bypass surgery and endovascular interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Chronic atherosclerotic occlusion of the femoropopliteal-tibial segment causes critical limb ischemia.
- Surgical interventions aim to restore arterial blood flow and prevent amputation.
- Patient outcomes are influenced by comorbidities, particularly coronary and cerebral circulation issues.
Purpose of the Study:
- To analyze the outcomes of surgical treatments for chronic atherosclerotic occlusion.
- To develop and validate a surgical risk assessment scale for patients with critical limb ischemia.
- To guide the selection of optimal revascularization strategies based on patient risk.
Main Methods:
- Retrospective analysis of 93 patients with critical limb ischemia undergoing autovenous femoropopliteal bypass or balloon angioplasty with stenting.
- Development of a surgical risk scale considering concomitant diseases, especially cardiovascular and cerebrovascular lesions.
- Evaluation of survival rates without amputation and incidence of complications at three years.
Main Results:
- Three-year survival rates without amputation were 71.4% (low risk), 60.0% (moderate risk), and 43.3% (high risk).
- High-risk patients exhibited a >40% incidence of cardiac and cerebrovascular complications.
- The developed risk assessment scale accurately predicted patient survival post-reconstruction.
Conclusions:
- The established surgical risk assessment system objectively reflects prognosis in patients undergoing arterial reconstruction for femoropopliteal-tibial atherosclerotic lesions.
- The risk scale aids in optimizing treatment selection between bypass surgery and endovascular interventions.
- High-risk patients may benefit from endovascular reconstruction, while low-risk patients are better suited for bypass surgery; moderate-risk patients can be considered for either approach.
Abstract:
Analysed herein are both immediate and remote results of surgical treatment of 93 patients presenting with chronic atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The patients were subjected to autovenous femoropopliteal bypass grafting to the isolated arterial segment or balloon angioplasty with stenting of the superficial femoral artery. While choosing the method of arterial reconstruction we assessed concomitant diseases, primarily lesions of the coronary and cerebral circulation. In order to objectively evaluate the patient state, we worked out a scale for assessing surgical risk. Survival rate without amputation after three years in patients with low risk amounted to 71.4%, in those with moderate risk to 60.0%, and in high-risk patients to 43.3%. Patients with initially high risk were found to have a high incidence rate of cardiac and cerebrovascular complications, exceeding 40%. It was shown that the worked out system of assessing the level of surgical risk objectively reflects the prognosis of patient survival following a reconstructive operation. This system of assessment may be appropriate while choosing an optimal method of arterial reconstruction (bypassing operation or endovascular intervention) in patients with atherosclerotic lesions of arteries of the femoropopliteal-tibial segment and critical ischaemia accompanied by severe concomitant pathology. Patients with high surgical risk should preferably be subjected to endovascular reconstruction, while those with low surgical risk should better undergo open shunting bypassing operation, and for those with moderate risk it is acceptable to perform both methods of arterial reconstruction.
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