[Iliac artery reconstruction in patients with chronic critical limb ischemia: endarterectomy or replacement]
B V Kozlovsky1, I P Mikhailov1, E V Kungurtsev1
1Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.
Insights
Iliac artery endarterectomy is a safe and effective treatment for chronic critical lower limb ischemia, showing comparable patency to replacement but with fewer complications, especially for trophic disorders.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Chronic critical lower limb ischemia (CLI) poses significant challenges in vascular surgery.
- Treatment options for CLI include surgical revascularization and endovascular interventions.
- Iliac artery disease is a common cause of CLI, necessitating effective treatment strategies.
Purpose of the Study:
- To compare the effectiveness and postoperative morbidity of iliac artery endarterectomy versus ilio-femoral and aorto-femoral bypass in patients with CLI.
- To evaluate the long-term patency rates and complication profiles of these surgical approaches.
- To determine the optimal surgical strategy for CLI patients with trophic complications.
Main Methods:
- A retrospective study of 95 patients with CLI.
- Patients underwent either iliac artery endarterectomy (52 cases) or ilio-femoral/aorto-femoral bypass (43 cases).
- Analysis of postoperative complications, including wound infection, hernia, perforation, and thrombosis, and 12-month patency rates.
Main Results:
- Iliac artery replacement had a complication rate of 11.6% (wound suppuration, infection, hernia).
- Endarterectomy had a complication rate of 7.7% (perforation, thrombosis), comparable to literature data.
- Successful endarterectomy was achieved in 88.1% of patients, with similar iliac segment patency to bypass at 12 months.
Conclusions:
- Iliac artery endarterectomy demonstrates advantages over bypass surgery for CLI.
- Endarterectomy is a preferred option for patients with CLI, particularly those with trophic complications.
- Both endarterectomy and bypass provide similar long-term patency for the iliac segment in CLI patients.
Objective:
To evaluate the effectiveness and postoperative morbidity after endarterectomy from the iliac arteries in comparison with ilio-femoral and aorto-femoral replacement in patients with chronic critical lower limb ischemia.
Material And Methods:
There were 95 patients with chronic critical lower limb ischemia. Iliac artery replacement was carried out in 43 (45.3%) patients, endarterectomy from the iliac arteries - in 52 (54.7%) cases. Trophic disorders on the lower extremities occurred in 36 (37.9%) patients.
Results:
Iliac artery replacement was accompanied by postoperative wound suppuration and infection of prosthesis in 3 (6.9%) patients, postoperative ventral hernia in 2 (4.7%) patients. The total number of complications specific for endarterectomy (iliac artery perforation - 1 (1.9%) patient, iliac artery thrombosis - 3 (5.8%) patients) was similar to the literature data. Successful endarterectomy was performed in 52 (88.1%) patients. Iliac segment patency was similar in both groups throughout a 12-month follow-up period.
Conclusion:
Endarterectomy from the iliac arteries has some advantages over replacement and should be preferred for trophic complications on the lower extremities.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Aneurysm III: Interprofessional Care