CLINICAL OUTCOMES AND COMPLICATIONS OF ENDOVASCULAR SURGERY IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

The aim: To review the results of endovascular treatment in patients with chronic threatening ischemia of lower extremities as well as to assess the level of complications developed after the use of modern endovascular technologies.

Materials and methods: 243 patients with occlusive-stenotic lesions of major arteries of infrarenal aorta, operated on by various endovascular techniques, were studied. 51 of them (20.98%) had multi-level lesions. All experimental group patients (83) were thoroughly evaluated preoperatively including assessment of probable development of arterial thrombosis of affected extremity after the surgery. Besides, endovascular treatment algorithm developed and introduced by the authors on the basis of individual anatomical and hemodynamic parameters was used.

Results: Thrombosis was the major early postoperative complication in both study groups, being registered in 21 patients (10.6%). The incidence of thrombosis was statistically higher in the control group as compared to experimental group - 11.53% and 7.14%, respectively (p<0.05). 15 patients of both groups underwent amputations - 12 patients (7.5%) in the control group, and 3 patients (3.6%) in experimental group. Early postoperative mortality rate was 2.56% in the control group, while there were no deaths in experimental group in early postoperative period.

Conclusions: Continuous ultrasound monitoring, avoidance of subintimal positioning of endovascular devices, use of rotary-mechanical thromboaspiration, drug-coated balloons and stents, regional thrombolytic therapy, as well as the concept of angiosome-directed therapy used in the study for restoration of artery patency, made it possible to improve treatment outcomes and decrease complications.