Diagnostics and treatment of patients with chronic limb ischemia (single-center experience)

BACKGROUND: The success of treating the patients with chronic ischemia of the lower limbs consists of a number of components, such as the full-scale diagnostics; the re-vascularisation volume, the therapeutic means (including the use of modern developments in angiogenesis); the engagement of specialists from the adjacent fields. AIM: the improvement of treatment results in patients with chronic ischemia in the lower limbs and developing an optimal treatment and diagnostic algorithm for this group of patients. METHODS: The analysis included the treatment results of 218 patients with chronic ischemia of the lower limbs (136 males, 82 females; the mean age was 67±6 years), of which 144 patients were operated, 74 were treated conservatively. Diagnostics and examination methods: ultrasound angioscanning, single-photon emission computed tomography combined with three-phase scintigraphy and computed tomography, consulting by a neurologist and a cardiologist, electroneuromyography by prescription from the neurologist and additional examinations by prescription from the cardiologist. The follow-up was implemented as the control out-patient examinations or upon the repeated hospitalization. The follow-up period was 6 months. RESULTS: The distribution of patients by the degree of ischemia as per the classification by А.V. Pokrovsky was the following: IIА — 57 (26.1%), IIB — 31 (14.2%), III — 42 (19.2%), IV — 88 (40.5%) patients. The number of open-access surgeries conducted was 56 (25.7%), with 64 endovascular (29.4%) and 24 hybrid ones (11.0%); conservative therapy was administered to 40 patients (18.3%), conservative therapy accompanied by additional administrations of plasma-free auto-platelet lysate — 34 (15.6%). In the group of operated patients, there were no significant differences depending on the method of surgical treatment at the early post-surgery period and after 6 months of follow-up (p >0.05). Among the patients receiving conservative therapy, the best results at the follow-up of 6 months were reported in patients, in which the standard therapy was accompanied by stimulation of angiogenesis with auto-platelet factors (p <0.05). The presence of ischemic neuropathy was investigated in 98 patients. Neuropathy was detected in 69 cases using the method of electroneuromyography. After prescribing the neurotropic therapy, resolving of neuropathic pain was reported in 52 (75.4%) patients. CONCLUSION: The multi-disciplinary approach developed by us for the diagnostics and treatment of patients with chronic ischemia of the lower limbs, allows for improving the treatment results, while the extended spectrum of diagnostic methods allows for evaluating the risk factors, for determining the optimal treatment tactics and for objectively evaluating the dynamic changes of the patient status.