Complex treatment of patients with chronic critical lower limb ischemia in multifocal arterial lesions complicated by trophic defects

Mikhailov I.P.; Kozlovsky B.V.; Kudryashova N.E.; Borovkova N.V.; Migunova E.V.; Leshchinskaya O.V.; Ponomarev I.N.

doi:https://doi.org/10.17116/kardio202114061505

Mikhailov I.P.

Sklifosovsky Research Institute for Emergency Care

Kozlovsky B.V.

Sklifosovsky Research Institute of Emergency Care

Kudryashova N.E.

Sklifosovsky Research Institute of Emergency Care

Borovkova N.V.

Sklifosovsky Research Institute of Emergency Care

Migunova E.V.

Sklifosovsky Research Institute of Emergency Care

Leshchinskaya O.V.

Sklifosovsky Research Institute of Emergency Care

Ponomarev I.N.

Sklifosovsky Research Institute of Emergency Care

ORCID: 0000-0002-2523-6939

Complex treatment of patients with chronic critical lower limb ischemia in multifocal arterial lesions complicated by trophic defects

Authors:

Mikhailov I.P., Kozlovsky B.V., Kudryashova N.E., Borovkova N.V., Migunova E.V., Leshchinskaya O.V., Ponomarev I.N.

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(6): 505‑511

DOI: 10.17116/kardio202114061505

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To cite this article:

Mikhailov IP, Kozlovsky BV, Kudryashova NE, Borovkova NV, Migunova EV, Leshchinskaya OV, Ponomarev IN. Complex treatment of patients with chronic critical lower limb ischemia in multifocal arterial lesions complicated by trophic defects. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(6):505‑511. (In Russ.)
https://doi.org/10.17116/kardio202114061505

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

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OBJECTIVE

To estimate the effectiveness of surgical treatment and complex conservative therapy in patients with chronic critical lower limb ischemia complicated by trophic defects.

MATERIAL AND METHODS

We analyzed treatment outcomes in 83 patients with chronic critical lower limb ischemia for the period 2018-2020.

RESULTS

Patients were divided into 2 groups: group I — 56 patients who underwent revascularization; subgroup IIa — 36 patients who received only conservative therapy; subgroup IIb — 14 patients who received complex conservative therapy and cell therapy. Microcirculation was assessed using three-phase scintigraphy. Clinical assessment considered resting pain relief and healing of trophic defects. The follow-up period was 6 months. The number of patients with improved local status and microcirculation was 41 (73.2%) in group I, 17 (47.2%) in subgroup IIa, 9 (64.8%) in subgroup IIb. Four (3.8%) patients died.

CONCLUSION

Direct revascularization of lower limbs is the most effective method in patients with trophic complications. Conservative therapy supplemented by cell therapy ensures better long-term outcomes compared to standard therapy. Three-phase scintigraphy is an objective method for assessing the effectiveness of treatment in patients with tropic defects.

Keywords:

chronic critical ischemia

trophic complications

revascularization of the lower extremities

conservative therapy

stem cell autotransplantation

three-phase scintigraphy

Authors:

Mikhailov I.P.

Sklifosovsky Research Institute for Emergency Care

Kozlovsky B.V.

Sklifosovsky Research Institute of Emergency Care

Kudryashova N.E.

Sklifosovsky Research Institute of Emergency Care

Borovkova N.V.

Sklifosovsky Research Institute of Emergency Care

Migunova E.V.

Sklifosovsky Research Institute of Emergency Care

Leshchinskaya O.V.

Sklifosovsky Research Institute of Emergency Care

Ponomarev I.N.

Sklifosovsky Research Institute of Emergency Care

ORCID: 0000-0002-2523-6939

Received:

11.01.2021

Accepted:

16.03.2021

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References:

Chervyakov YuV, Kha KhN, Gavrilenko AV, Klimov AE. Possibilities of using the WIfI classification system in patients with critical limb ischemia. Klinicheskaya i eksperimental’naya khirurgiya. Zhurnal im. akad. B.V. Petrovskogo. 2019;7(1):54-61. (In Russ.). https://doi.org/10.24411/2308-1198-2019-11007
Pokrovsky AV, Kazakov YuI, Lukin IB. Critical ischemia of the lower extremities. Infrainguinal lesion. Tver: Izdatel’stvo Tverskogo gosudarstvennogo universiteta; 2018. (In Russ.).
Pennywell DJ, Tan TW, Zhang WW. Optimal management of infrainguinal arterial occlusive disease. Vasc Health Risk Manag. 2014; 10:599-608. https://doi.org/10.2147/VHRM.S50779
Gentile F, Lundberg G, Hultgren R. Outcome for Endovascular and Open Procedures in Infrapopliteal Lesions for Critical Limb Ischemia: Registry Based Single Center Study. Eur J Vasc Endovasc Surg. 2016;52(5):643-649. https://doi.org/10.1016/j.ejvs.2016.07.013
Zubova ES, Vavilov VN, Artyushin BS, Movchan KN, Krutikov AN, Romanenkov NS, Iskhakov RB. Application of monocyte hematopoietic cells in the treatment of patients with critical lower limb ischemia. Sovremennye problemy nauki i obrazovaniya. 2019;3:177. (In Russ.).
Becker F, Robert EH, Ricco JB, Setacci C, Cao P, de Donato G, Eckstein HH, De Rango P, Diehm N, Schmidli J, Teraa M, Moll FL, Dick F, Davies AH, Lepäntalo M, Apelqvist J. Definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011;42(Suppl 2):4-12. https://doi.org/10.1016/S1078-5884(11)60009-9
Kret MR, Perrone KH, Azarbal AF, Mitchell EL, Liem TK, Landry GJ, Moneta GL. Medical comorbidities but not interventions adversely affect survival in patients with intermittent Claudication. J Vasc Surg. 2013;58(6):1540-1546. https://doi.org/10.1016/j.jvs.2013.07.012
Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58(1S):S1-S109.e33. https://doi.org/10.1016/j.ejvs.2019.05.006
Lebedev SV, Karasev AV, Kungurtsev VV, Lokhonina AV, Kleimenova EB. Cell therapy of critical lower limb ischemia (problems and prospects). Vestnik Rossiiskoj akademii meditsinskikh nauk. 2013;68(3):33-44. (In Russ.). https://doi.org/10.15690/vramn.v68i3.598
Powell RJ, Marston WA, Berceli SA, Guzman R, Henry TD, Longcore AT, Stern TP, Watling S, Bartel RL. Cellular therapy with Ixmyelocel-T to treatcritical limb ischemia: therandomized, double-blind, placebo-controlled RESTORE-CLI trial. Mol Ther. 2012;20(6):1280-1286. https://doi.org/10.1038/mt.2012.52
Peeters Weem SM, Teraa M, de Borst GJ, Verhaar MC, Moll FL. Bone marrow derived cell therapy in critical limb ischemia: A metaanalysis of randomized placebo controlled trials. Eur J Vasc Endovasc Surg. 2015;50(6):775-783. https://doi.org/10.1016/j.ejvs.2015.08.018
National guidelines for the diagnosis and treatment of peripheral artery disease. (In Russ.). Accessed December 15, 2020. https://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf
Kudryashova NE, Sinyakova OG, Mikhailov IP, Migunova EV, Leshchinskaya OV. Radionuclide semiotics of ischemia in acute arterial occlusion of lower limbs. Russian Sklifosovsky Journal “Emergency Medical Care”. 2019;8(3):257-265. (In Russ.). https://doi.org/10.23934/2223-9022-2019-8-3-257-265
Katelnitsky II. Quantitative vascular evaluation in patients with atherosclerotic lesions of the lower limb arteries undergoing therapeutic angiogenesis. Kletochnaya transplantologiya i tkanevaya inzheneriya. 2013;8(4):88-90. (In Russ.).