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Management of concomitant occlusive disease of the supraaortic and lower-limb arteries
Insights
Cerebrovascular disease is common in patients with lower limb occlusive disease. Prioritizing supraaortic vessel reconstruction before extensive peripheral procedures significantly reduces neurological risks.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Peripheral occlusive disease of the lower limbs frequently coexists with cerebrovascular disease.
- Clinical-neurological examinations alone may underestimate the prevalence of extracranial cerebral artery lesions.
Purpose of the Study:
- To determine the incidence of extracranial cerebral artery lesions in patients with peripheral occlusive disease.
- To evaluate the safety and efficacy of staged versus simultaneous surgical reconstruction of supraaortic and peripheral arteries.
Main Methods:
- Angiography was used to examine extracranial cerebral arteries in patients with peripheral occlusive disease.
- A cohort of patients underwent surgical reconstruction of both vascular systems.
Main Results:
- 61.5% of patients exhibited extracranial cerebral artery lesions requiring intervention.
- No postoperative neurological dysfunction occurred in 48 patients who had staged reconstructions of both supraaortic and peripheral arteries.
Conclusions:
- Staged surgical reconstruction, prioritizing supraaortic vessels, is essential for minimizing risks in patients with combined arterial occlusive disease.
- Simultaneous treatment of concomitant supraaortic and peripheral arterial occlusive disease is not recommended.
Abstract:
Angiography examinations of the extracranial cerebral arteries in patients with peripheral occlusive disease of the lower limbs indicate cerebro-vascular disease more often than might be assumed from clinical-neurological examinations alone. In total, 61.5% of the patients examined showed lesions of the extracranial cerebral arteries which necessitated an operation. The elimination of risks in an operation requiring extensive peripheral vessel reconstruction necessitates initial supraaortic vessel reconstruction. Of the 48 patients with reconstructions in both vascular systems, none has suffered any postoperative neurological dysfunction. Concomitant occlusive disease of the supraaortic and peripheral arteries should not be treated simultaneously.