Long-term outcomes of two treatment strategies for critical limb ischemia combined with coronary artery disease

Alekyan B.G.; Karapetyan N.G.; Chupin A.V.; Zotikov A.E.; Varava A.B.; Ushakov A.A.; Geletsyan L.G.; Norvardyan A.M.

doi:https://doi.org/10.17116/Cardiobulletin20221702155

Alekyan B.G.

Vishnevsky National Medical Research Center of Surgery

Karapetyan N.G.

Vishnevsky National Medical Research Center of Surgery

Chupin A.V.

Vishnevsky National Medical Research Center of Surgery

Zotikov A.E.

Vishnevsky National Medical Research Center of Surgery

Varava A.B.

A.V. Vishnevsky National Research Center for Surgery

Ushakov A.A.

Vishnevsky National Medical Research Center of Surgery

Geletsyan L.G.

Vishnevsky National Medical Research Center of Surgery

Norvardyan A.M.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0001-5465-9378

Long-term outcomes of two treatment strategies for critical limb ischemia combined with coronary artery disease

Authors:

Alekyan B.G., Karapetyan N.G., Chupin A.V., Zotikov A.E., Varava A.B., Ushakov A.A., Geletsyan L.G., Norvardyan A.M.

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Journal: Russian Cardiology Bulletin. 2022;17(2): 55‑64

DOI: 10.17116/Cardiobulletin20221702155

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To cite this article:

Alekyan BG, Karapetyan NG, Chupin AV, et al. . Long-term outcomes of two treatment strategies for critical limb ischemia combined with coronary artery disease. Russian Cardiology Bulletin. 2022;17(2):55‑64. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20221702155

Подписка 2026 Кардиологический вестник (Russian Cardiology Bulletin)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the long-term results of two treatment strategies for critical limb ischemia (CLI) combined with coronary artery disease (CAD).

MATERIAL AND METHODS

A single-center retrospective study included 102 patients with CLI and CAD who underwent endovascular and open surgical interventions in both vascular beds. Cardiovascular team made a decision regarding the method and stages of revascularization. Patients were divided into 2 groups depending on revascularization strategy for both arterial systems: group 1 — endovascular treatment (staged PCI and angioplasty of lower limb arteries) (n=53, 50.3%); group 2 — combined treatment (staged PCI combined with open bypass procedures for claudication) (n=49, 48.0%). Long-term treatment outcomes within 7 — 51 months (median 31.5 months) were studied in 85 (85%) out of 100 patients discharged from the Center considering the data of repeated hospitalizations (13.0%), outpatient examinations (34.2%), survey and telephone interviewing (52.8%).

RESULTS

Overall mortality was 14.1% (13.6% and 4.6%, respectively, p=0.89)). Overall cardiovascular mortality was 7.0% (6.8% and 7.3%, respectively p=0.92), overall non-cardiovascular mortality — 7.0% (6.8% and 7.3%, respectively, p=0.92). Overall incidence of stroke was 3.5% (4.5% and 2.4%, respectively, p=0.59). Recurrence of angina occurred in 2.3% of patients in the 1^st group and no recurrence of angina was observed in the 2^nd group. Overall incidence of recurrent lower limb ischemia was 7.0% (9.0% and 5.0%, respectively, p=0.44), overall incidence of amputations of lower extremities — 3.5% (4.5% and 2.4%, respectively, p=0.59). Non-fatal myocardial infarction was absent in both groups.

CONCLUSION

Incidence of cardiovascular complications and adverse events in lower limb arteries was similar in long-term follow-up period after endovascular (group 1) and combined treatment (group 2) of patients with CLI and CAD (p>0.5). Overall long-term cardiovascular mortality was 7.0%, incidence of stroke — 3.5%. Non-fatal myocardial infarction was not detected in both groups. Both treatment strategies in patients with CLI and CAD showed high safety and clinical efficacy in early and long-term postoperative periods and can be widely used in everyday clinical practice.

Keywords:

percutaneous coronary interventions

combined lesion of coronary and lower limb arteries

multifocal atherosclerosis

lower limb artery bypass grafting

stenting and balloon angioplasty of lower limb arteries

critical limb ischemia

diabetic foot

Authors:

Alekyan B.G.

Vishnevsky National Medical Research Center of Surgery

Karapetyan N.G.

Vishnevsky National Medical Research Center of Surgery

Chupin A.V.

Vishnevsky National Medical Research Center of Surgery

Zotikov A.E.

Vishnevsky National Medical Research Center of Surgery

Varava A.B.

A.V. Vishnevsky National Research Center for Surgery

Ushakov A.A.

Vishnevsky National Medical Research Center of Surgery

Geletsyan L.G.

Vishnevsky National Medical Research Center of Surgery

Norvardyan A.M.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0001-5465-9378

Received:

11.11.2021

Accepted:

22.03.2022

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