Comparison of the effectiveness of open revascularization operations with simultaneous damage to the arteries of the aorto-femoral and femoral-popliteal segments in patients with critical lower limb ischemia depending on the level of peripheral vascular resistance

Danilova D.O.¹, Gusinkiy A.V.^1,2, Shlomin V.V.^{1, 2}, Zhdanovich K.V.^{1, 2}, Kucherenko V.S.¹, Fionik O.V.¹

Rationale: Multilevel atherosclerotic lesions of the lower extremity arteries are most commonly associated with the development of critical ischemia. Despite the prevalence of lesions of several arterial segments, there is no clear algorithm for performing revascularization operations. The choice of treatment tactics and the type of reconstructive surgery is still insufficiently reflected in the literature. Evaluation of the results of revascularization operations depending on the initial anatomy of the lesion of peripheral arteries and the state of the outflow channel in order to preoperative predict the effectiveness of revascularization became the basis for this study.

Objective: to evaluate the results of revascularization operations in patients with multilevel atherosclerotic lesion of the arteries of the lower extremities, depending on the state of the peripheral outflow channel and deep femoral artery.

Materials and methods: The study was retrospective in nature and was conducted on the basis of the Department of Vascular Surgery of St. Petersburg State Medical Institution "City Multidisciplinary Hospital №2". The study included 236 patients observed in the department between 2013 and 2024, of whom 179 patients were re-hospitalized. All patients had a multi-stage lesion of the arteries of the lower extremities. All patients were assessed in points of the outflow tracts proposed by R.B. Rutherford in 1997, with changes by A.V. Pokrovsky as modified by L.A. Maslov.

Results: The results of revascularization were studied depending on the nature of the surgical intervention performed and the condition of the deep femoral artery for 132 months in groups of patients with low (less than 5.0 points) and high (more than 6.0 points) peripheral resistance of the outflow channel outflow tract.

Conclusions: The revealed clear relationship between the level of peripheral vascular resistance and the results of reconstructive operations allows us to recommend the optimization of hemodynamic conditions of the outflow channel to improve the patency of vascular structures.

1. Kazakov YUI, Lukin IB, Sokolova NYU, et al. Ocenka hirurgicheskogo riska u bol’nyh s hronicheskoj kriticheskoj ishemiej nizhnih konechnostej. Angiologiya i sosudistaya hirurgiya. 2016; 22(3): 139-144. (In Russ.)

2. Yаnushko VA, Turlyuk DV, Ladygin PA, et al. Sovremennnye podhody diagnostiki i lecheniya mnogourovnevyh porazhenij arterij nizhnih konechnostej nizhe pahovoj skladki v stadii kriticheskoj ishemii. Novosti hirurgii. 2011; 19(6): 115-128. (In Russ.)

3. Kharazov AF, Luchkin VM, Basirova NM, et al. Case of successful hybrid revascularization and limb salvage in patient with CLI after multiply ABF thrombosis and absence of outflow arteries. Aterotromboz. 2020; 2: 130-142. (In Russ.) doi: 10.21518/2307-1109-2020-2-130-142.

4. Katelnitskiy II. Risk factors affecting on late results of surgical treatment of patients with atherosclerosis obliterans in critical limb ischemia. Medicinskij vestnik Yuga Rossii. 2014; 1: 54-60. (In Russ.) doi: 10.21886/2219-8075-2014-1-54-60.

5. Matyushkin AV, Lobachev AА. Methods for improving the results of using a synthetic prosthesis in the popliteal-tibial segment in critical limb ischemia. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova. 2020; 28(2): 200-212. (In Russ.) doi: 10.23888/PAVLOVJ2020282200-212.

6. Shlomin VV, Gusinskiy AV, Gordeev ML, et al. Simultaneous revascularization of aortofemoral and femoropopliteal arterial segments by semiclosed loop endarterectomy. Vestnik hirurgii. 2017; 176(2): 28-32. (In Russ.)

7. Kulikovich JK, Lyzikov AA, Kaplan ML, et al. Long-term results of profundoplasty in patients with atherosclerotic lesions of the arteries of the lower extremities, depending on the state of the distal bed. Problemy zdorov'ya i ekologii. 2023; 20(3): 46-52. (In Russ.) doi: 10.51523/2708-6011.2023-20-3-06.

8. Maslov AL, Zotikov AE. Score assessment of outflow resistance in lesions of the femoropopliteal arteries using MSCT angiography. Medicinskaja vizualizacija. 2017; 21(2): 90-102. (In Russ.) doi: 10.24835/1607-0763-2017-2-90-102.

9. Gavrilenko AV, Kotov AE, Lepshokov MK. The advantages of deep femoral artery angioplasty in critical limb ischemia. Annaly Khirurgii. 2018; 23(1): 42-46 (In Russ.) doi: 10.18821/1560-9502-2018-23-1-42-46.

10. Gorohovskij SJu, Lyzikov AA, Kaplan ML, et al. Expediency and options for functional control in determining the extent of surgery for occlusive lesions of the lower extremity arteries. Novosti hirurgii. 2020; 28(5): 505-514 (In Russ.) doi: 10.18484/2305-0047.2020.5.505.