Ghoneim Baker, Elwan Hussein, Eldaly Waleed, Khairy Hussein, Taha Ahmad, Gad Amr
Vascular Surgery Unit, Faculty of Medicine, Cairo University, Giza, Egypt.
Int J Angiol. 2014 Sep;23(3):197-206. doi: 10.1055/s-0034-1382825.
This study aims at the assessment of the achievability of the endovascular treatment of patients with critical limb ischemia (CLI) and the role of bypass in such patient. This is a prospective study conducted on patients with chronic atherosclerotic critical lower limb ischemia presenting to us over a period of 3 years. Patients presenting with nonsalvageable limbs requiring primary major amputation and nonatherosclerotic causes of CLI were excluded. Endovascular treatment was the first choice modality of treatment in revascularization of all patients. Open surgery was offered selectively for patient whom endovascular failed or complicated and for long TransAtlantic Inter-Society Consensus (TASC) II lesions in fit patients. This study included 511 cases of CLI, and the mean age was 64.5 years. Patients with Rutherford IV, V, and VI were 19.25, 60.5, and 19.25%, respectively. The TASC II aortoiliac lesions were as follows: A, B, C, and D in 33.7, 12,15.7, and 38.6%, respectively, and infrainguinal lesions were A, B, C, and D in 3.7, 19, 35.4, and 68.3%, respectively. A total of 78.3% of patients were treated by endovascular totally, while 16% were treated by surgery from the start, 3.7% of endovascular cases were converted to open surgery after failure of endovascular treatment, and 2% was offered hybrid treatment. Crossing of lesions by subintimal and intraluminal was 12.5 and 87.5%, respectively. Technical success in endovascular was 94%; however, we could successfully revascularize 96.8% of all CLI presented in this study by either surgery or endovascular. On 24 months follow-up, primary patency, secondary patency, and limb salvage by percutaneous transluminal angioplasty are 77.8, 84.7, and 90.7%, respectively. Revascularization by endovascular achieves high technical success and limb salvage in CLI, hence should be considered as preferred choice of treatment. However, both endovascular and surgery should not be counteracting each other and using both can revascularize 96.6% of CLI.
本研究旨在评估严重肢体缺血（CLI）患者血管内治疗的可实现性以及旁路手术在此类患者中的作用。这是一项对3年来就诊于我院的慢性动脉粥样硬化性严重下肢缺血患者进行的前瞻性研究。排除需要一期大截肢的不可挽救肢体患者以及非动脉粥样硬化性CLI病因患者。血管内治疗是所有患者血运重建的首选治疗方式。对于血管内治疗失败或出现并发症的患者以及适合手术的长段跨大西洋两岸血管外科学会（TASC）II型病变患者，选择性地提供开放手术。本研究纳入511例CLI患者，平均年龄为64.5岁。Rutherford IV、V和VI级患者分别占19.25%、60.5%和19.25%。TASC II型主髂动脉病变情况如下：A、B、C和D级分别占33.7%、12%、15.7%和38.6%，股腘以下病变的A、B、C和D级分别占3.7%、19%、35.4%和68.3%。总共78.3%的患者完全接受血管内治疗，16%的患者从一开始就接受手术治疗，3.7%的血管内治疗病例在血管内治疗失败后转为开放手术，2%的患者接受杂交治疗。内膜下和腔内通过病变的比例分别为12.5%和8
