SURGICAL TREATMENT OF PATIENTS WITH CRITICAL LOWER LIMB ISCHEMIA AND CORONARY ARTERY DISEASE

Аннотация

The majority of patients with critical lower limb ischemia (CLLI) also suffer from coronary artery disease (CAD). After reconstructive operations in the aorto-iliac region, the risks of myocardial infarction and mortality remain high. Therefore, the sequence of coronary and limb revascularization remains a pressing issue. Keywords: critical lower limb ischemia; coronary artery disease; bifurcation aorto- femoral bypass; hybrid surgery. Materials and Methods. This study presents the outcomes of treatment in 131 patients with CLLI and CAD involving the aorto-iliac segment. All patients underwent lower limb revascularization as the first stage. Bifurcation aorto-femoral bypass (BAFB) was performed in 88 patients (67.2%), while 43 patients (32.8%) underwent hybrid reconstruction of the aorto-iliac segment, including open femoral artery reconstruction and endovascular iliac stenting. Critical ischemia was resolved in all patients. No deaths were recorded among patients who underwent hybrid procedures, whereas 1 patient (1.1%) died after BAFB. Results. After surgery, CLLI was eliminated in all patients (100%), as confirmed by disappearance of resting pain and an ankle–brachial index (ABI) increase above 0.4. In group 1, 1 patient (0.76%) developed acute myocardial infarction followed by death, and 5 patients (3.8%) developed acute coronary syndrome with ST-segment depression but without hemodynamic instability. In group 2, 4 patients (3.05%) developed acute coronary syndrome with ST-segment depression, but no deaths occurred. Conclusion. In patients with concomitant CLLI and CAD, the traditional staged approach is associated with high risks. Our findings indicate that hybrid surgery reduces surgical trauma, while at least 7 days of preoperative preparation improves cardiac stability. Optimal management should include preoperative preparation, hybrid surgical approaches, and an individualized assessment of risks.