[Conservative treatment of patients after peripheral arterial reconstruction for chronic critical limb ischemia]

Conservative management of patients after reconstructive vascular operations remains an important and widely discussed problem of modern medicine.

This study was aimed at evaluating efficacy and safety of combined administration of aspirin and low-dose rivaroxaban in patients with atherosclerosis who underwent reconstructive operations on arteries below the inguinal ligament for chronic critical lower limb ischemia.

Our prospective cohort study included a total of 182 patients with atherosclerosis and chronic critical lower limb ischemia. The patients' age ranged from 40 to 95 years (mean age 65.3±8.1 years). The period of the study was from 2018 to 2021. All patients underwent femoropopliteal bypass graft surgery with a distal anastomosis both above and below the knee-joint fissure, with either a reversed autovein or a synthetic graft used as a shunt. The patients were divided into 4 groups depending on the type of operation and prescribed therapy in the postoperative period. Control was carried out by means of clinical examination and duplex ultrasound angioscanning of lower-limb arteries after 30 days, as well as at 3, 6 and 12 postoperative months.

An unfavorable clinical outcome was defined as the development of either single or various combinations of such conditions as acute limb ischemia, major amputation, shunt thrombosis, acute myocardial infarction, acute cerebrovascular accident, cardiovascular death. They were reveled in the remote period after surgery (from 30 days to 12 month) in 4 (8.3%) Group 1 patients, 6 (13.6%) Group 2 patients, 6 (13.3%) Group 3 patients and in 11 (24.4%) Group 4 patients. Besides, there was 1 (2.6%) major gastrointestinal bleeding in Group 2, with no significant hemorrhagic events revealed in other groups (p=NS).

Low-dose rivaroxaban combined with aspirin proved effective in preventing major adverse limb events and safe as to hemorrhagic complications compared with a combination of aspirin and clopidogrel in patients after revascularization of lower extremities for chronic critical limb ischemia.