Iliac artery reconstruction in patients with chronic critical limb ischemia: endarterectomy or replacement

Kozlovsky B.V.

Sklifosovsky Research Institute of Emergency Care

Mikhailov I.P.

Sklifosovsky Research Institute for Emergency Care

Kungurtsev E.V.

Sklifosovsky Research Institute for Emergency Care

Isaev G.A.

Sklifosovsky Research Institute of Emergency Care

Verdikhanov N.I.

Sklifosovsky Research Institute of Emergency Care

Iliac artery reconstruction in patients with chronic critical limb ischemia: endarterectomy or replacement

Authors:

Kozlovsky B.V., Mikhailov I.P., Kungurtsev E.V., Isaev G.A., Verdikhanov N.I.

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Journal: Pirogov Russian Journal of Surgery. 2021;(4): 15‑20

DOI: 10.17116/hirurgia202104115

Downloaded: 63

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To cite this article:

Kozlovsky BV, Mikhailov IP, Kungurtsev EV, Isaev GA, Verdikhanov NI. Iliac artery reconstruction in patients with chronic critical limb ischemia: endarterectomy or replacement. Pirogov Russian Journal of Surgery. 2021;(4):15‑20. (In Russ.)
https://doi.org/10.17116/hirurgia202104115

Подписка 2025 (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To evaluate the effectiveness and postoperative morbidity after endarterectomy from the iliac arteries in comparison with ilio-femoral and aorto-femoral replacement in patients with chronic critical lower limb ischemia.

MATERIAL AND METHODS

There were 95 patients with chronic critical lower limb ischemia. Iliac artery replacement was carried out in 43 (45.3%) patients, endarterectomy from the iliac arteries — in 52 (54.7%) cases. Trophic disorders on the lower extremities occurred in 36 (37.9%) patients.

RESULTS

Iliac artery replacement was accompanied by postoperative wound suppuration and infection of prosthesis in 3 (6.9%) patients, postoperative ventral hernia in 2 (4.7%) patients. The total number of complications specific for endarterectomy (iliac artery perforation — 1 (1.9%) patient, iliac artery thrombosis — 3 (5.8%) patients) was similar to the literature data. Successful endarterectomy was performed in 52 (88.1%) patients. Iliac segment patency was similar in both groups throughout a 12-month follow-up period.

CONCLUSION

Endarterectomy from the iliac arteries has some advantages over replacement and should be preferred for trophic complications on the lower extremities.

Keywords:

critical ischemia

trophic complications

endarterectomy

iliac artery replacement

Authors:

Kozlovsky B.V.

Sklifosovsky Research Institute of Emergency Care

Mikhailov I.P.

Sklifosovsky Research Institute for Emergency Care

Kungurtsev E.V.

Sklifosovsky Research Institute for Emergency Care

Isaev G.A.

Sklifosovsky Research Institute of Emergency Care

Verdikhanov N.I.

Sklifosovsky Research Institute of Emergency Care

Received:

01.04.2020

Accepted:

21.05.2020

List of references:

Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, 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
Gavrilenko AV, Kravchenko AA, Shatalova DV. Treatment of patients with critical lower limb ischaemia: endovascular methods or reconstructive operations. Angiologiya i sosudistaya khirurgiya. 2017;23(3):145-151. (In Russ.).
Fokin AA, Vazhenin AV, Guzhin EV, Verbovetsky LP, Orekhova LA, Andrievskikh IA. Thrombendarterectomy from the external iliac artery. Angiologiya i sosudistaya khirurgiya. 1996;1:107-112. (In Russ.).
Gusinsky AV, Shlomin VV, Lebedev LV, Soloviev AV, Yurtaev EA, Sharipov EM, Kasyanov IV, Didenko YuP. Semiclosed endarterectomy of the aorto-femoral segment by vollmar loops. Vestnik khirurgii imeni I.I. Grekova. 2003;162(3):11-15. (In Russ.).
Smeets L, de Borst GJ, de Vries JP, van den Berg JC, Ho GH, Moll FL. Remote iliac artery endarterectomy: Seven-year results of a less invasive technique for iliac artery occlusive disease. J Vasc Surg. 2003;38(6): 1297-1304. https://doi.org/10.1016/s0741-5214(03)00929-7
Romanovich AV, Khryshchanovich VYa. Paraprosthetic infection in vascular surgery: current state of the problem. Novosti khirurgii. 2017;25(3):292-299. (In Russ.). https://doi.org/10.18484/2305-0047.2017.3.292
Charlton-Ouw KM, Sandhu HK, Huang G, Leake SS, Miller CC, Estrera AL, Azizzadeh A, Safi HJ. Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts. J Vasc Surg. 2014;59(3):684-692. https://doi.org/10.1016/j.jvs.2013.09.030
Zatevakhin II, Komrakov VE. Infection in vascular surgery. M. 1998. (In Russ.).
Koval OA, Zoloev GK. Semiclosed endarterectomy from iliac arteries under duplex scanning. Khirurgiya. Zhurnal im. N.I. Pirogova. 2014;(8):49-52. (In Russ.).
Zoloev GK, Koval OA, Litvinovsky SV, Ivatsin NP. Specific complications of semi-closed endarterectomy from the iliac arteries. Angiologiya i sosudistaya khirurgiya. 2006;12(4):121-126. (In Russ.).
Beno M, Rumenapf G. Retrograde endarterectomy of iliac arteries. Bratisl Lek Listy. 2010;111(2):83-89.
Simó G, Banga P, Darabos G, Mogán I. Stent-assisted remote iliac artery endarterectomy: an alternative approach to treating combined external iliac and common femoral artery disease. Eur J Vasc Endovasc Surg. 2011;42(5):648-655. https://doi.org/10.1016/j.ejvs.2011.06.005
Sedov VM, Gusinsky AV, Shlomin VV, Shatravka AV, Kasyanov IV, Vazhenin SO, Nikolaev DN, Kokh BB. Analiz rannikh posleoperatsionnykh oslozhnenij posle rekonstruktivnykh operatsij na arteriyakh aorto-bedrennogo segmenta. Vestnik Sankt-Peterburgskogo universiteta. 2008;11(1):60-70. (In Russ.).
Papoyan SA, Shchegolev AA, Gavrilenko AV. Modern approaches to surgical and endovascular treatment of the aorto-iliac segment lesions. Annaly khirurgii. 2015;(5):11-17. (In Russ.).

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