THE RESULTS OF TREATMENT OF PATIENTS WITH INTERMITTENT CLAUDICATION IN COMBINATION WITH CORONARY HEART DISEASE


Cite item

Full Text

Abstract

Relevance. Chronic lower limb ischemia (CLLI) is associated with a two-fold increase in the risk of mortality, mainly from cardiovascular disease. Progression of coronary heart disease (CHD) and CINK stage 2B according to Fontaine-Pokrovsky leads to the development of large cardiovascular events in the hospital and long-term periods, can lead to the development of critical ischemia of the lower extremities, as well as amputations in the absence of treatment. The main goal in the treatment of these patients is to preserve the lower extremities and reduce cardiovascular risk, in particular, reduce the number of myocardial infarctions (MI). To date, there is no single point of view in choosing a strategy for the treatment of patients with stage 2B CLCI, in whom conservative therapy was ineffective, in combination with concomitant significant damage to the coronary arteries. Purpose. To evaluate the results of treatment in patients with CLII stage 2B in combination with coronary artery disease. Materials and methods. On the basis of the National Medical Research Center for Surgery named after A.V. Vishnevsky, the results of treatment in 92 patients with CLII stage 2B in combination with coronary artery disease were analyzed. Patients were divided into 2 groups: group 1 - PCI and lower limb artery stenting (LEA) and group 2 - PCI and open surgery for LA. Among 92 patients, 70 (76%) were men. The mean age of the patients was 65.7 ± 7.7 years. Angina pectoris II-III FC according to CCS occurred in 72 (78.2%) patients, painless form of myocardial ischemia - in 20 (21.8%). Single-vessel coronary artery disease (narrowing over 50%) was diagnosed in 23 (25%) patients, two-vessel lesion in 34 (36.9%), and three-vessel lesion in 35 (38%) patients. In 72 (78.2%) patients, a unilateral lesion of the ANC was diagnosed, in 20 (21.7%) - bilateral. Results. At the hospital stage, no MI, stroke, or deaths were observed in both groups. In the long-term period, the results were evaluated in 76 (82.6%) of 92 patients: group 1 - 37 (48.7%) and group 2 - 39 (51.3%) of 76 evaluated patients. In group 1, 2 (5.4%) patients out of 37 experienced 2 (5.4%) MI and 1 (2.7%) death due to pneumonia. In group 2, 1 (2.5%) of 39 had a non-fatal MI. There were 5 (12.8%) deaths in total: 2 (5.1%) MI, 1 (2.5%) oncology, 2 (5.1%) complications after COVID-19. Conclusions. 1. X-ray endovascular and combined strategies for the treatment of patients with CLCI in combination with coronary artery disease showed their safety and effectiveness. When performing 198 interventions in 92 patients (average 2.1 operations per 1 patient), no severe cardiovascular complications were observed. We suggest that timely PCI in patients with CLCI helps to avoid major cardiovascular complications.

Full Text

Relevance. Chronic lower limb ischemia (CLLI) is associated with a two-fold increase in the risk of mortality, mainly from cardiovascular disease. Progression of coronary heart disease (CHD) and CINK stage 2B according to Fontaine-Pokrovsky leads to the development of large cardiovascular events in the hospital and long-term periods, can lead to the development of critical ischemia of the lower extremities, as well as amputations in the absence of treatment. The main goal in the treatment of these patients is to preserve the lower extremities and reduce cardiovascular risk, in particular, reduce the number of myocardial infarctions (MI). To date, there is no single point of view in choosing a strategy for the treatment of patients with stage 2B CLCI, in whom conservative therapy was ineffective, in combination with concomitant significant damage to the coronary arteries. Purpose. To evaluate the results of treatment in patients with CLII stage 2B in combination with coronary artery disease. Materials and methods. On the basis of the National Medical Research Center for Surgery named after A.V. Vishnevsky, the results of treatment in 92 patients with CLII stage 2B in combination with coronary artery disease were analyzed. Patients were divided into 2 groups: group 1 - PCI and lower limb artery stenting (LEA) and group 2 - PCI and open surgery for LA. Among 92 patients, 70 (76%) were men. The mean age of the patients was 65.7 ± 7.7 years. Angina pectoris II-III FC according to CCS occurred in 72 (78.2%) patients, painless form of myocardial ischemia - in 20 (21.8%). Single-vessel coronary artery disease (narrowing over 50%) was diagnosed in 23 (25%) patients, two-vessel lesion in 34 (36.9%), and three-vessel lesion in 35 (38%) patients. In 72 (78.2%) patients, a unilateral lesion of the ANC was diagnosed, in 20 (21.7%) - bilateral. Results. At the hospital stage, no MI, stroke, or deaths were observed in both groups. In the long-term period, the results were evaluated in 76 (82.6%) of 92 patients: group 1 - 37 (48.7%) and group 2 - 39 (51.3%) of 76 evaluated patients. In group 1, 2 (5.4%) patients out of 37 experienced 2 (5.4%) MI and 1 (2.7%) death due to pneumonia. In group 2, 1 (2.5%) of 39 had a non-fatal MI. There were 5 (12.8%) deaths in total: 2 (5.1%) MI, 1 (2.5%) oncology, 2 (5.1%) complications after COVID-19. Conclusions. 1. X-ray endovascular and combined strategies for the treatment of patients with CLCI in combination with coronary artery disease showed their safety and effectiveness. When performing 198 interventions in 92 patients (average 2.1 operations per 1 patient), no severe cardiovascular complications were observed. We suggest that timely PCI in patients with CLCI helps to avoid major cardiovascular complications.

×

About the authors

Marat Sedgaryan

The National Medical Research Center of Surgery named after A. Vishnevsky

Author for correspondence.
Email: sedgaryan@gmail.com
ORCID iD: 0000-0003-1876-7421
Russian Federation

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies