[Assessment of surgical risk in patients with lower limb chronic critical ischaemia].
Analysed herein are both immediate and remote results of surgical treatment of 93 patients presenting with chronic atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The patients were subjected to autovenous femoropopliteal bypass grafting to the isolated arterial segment or balloon angioplasty with stenting of the superficial femoral artery. While choosing the method of arterial reconstruction we assessed concomitant diseases, primarily lesions of the coronary and cerebral circulation. In order to objectively evaluate the patient state, we worked out a scale for assessing surgical risk. Survival rate without amputation after three years in patients with low risk amounted to 71.4%, in those with moderate risk to 60.0%, and in high-risk patients to 43.3%. Patients with initially high risk were found to have a high incidence rate of cardiac and cerebrovascular complications, exceeding 40%. It was shown that the worked out system of assessing the level of surgical risk objectively reflects the prognosis of patient survival following a reconstructive operation. This system of assessment may be appropriate while choosing an optimal method of arterial reconstruction (bypassing operation or endovascular intervention) in patients with atherosclerotic lesions of arteries of the femoropopliteal-tibial segment and critical ischaemia accompanied by severe concomitant pathology. Patients with high surgical risk should preferably be subjected to endovascular reconstruction, while those with low surgical risk should better undergo open shunting bypassing operation, and for those with moderate risk it is acceptable to perform both methods of arterial reconstruction.
Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation, Tver, Russia; Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia.
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Kazakov
Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation, Tver, Russia; Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia.
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Lukin
Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia.
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Sokolova
Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation, Tver, Russia; Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia.
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Strakhov
D000368:Aged; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D000066491:Clinical Decision-Making; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D020379:Risk Adjustment; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods