In recent years, there has been a progressive increase in the incidence of
obliterative atherosclerosis of the pelvic and lower extremity arteries, as evidenced by
the results of numerous studies.
In Ukraine, chronic occlusive diseases of the lower extremity arteries account for
more than 20% of all cardiovascular pathologies. It accounts for 20% of all patients with
cardiovascular disease, or about 800-1000 patients per 1 million people.
Obliterating arteriosclerosis with symptoms of severe lower limb ischemia occurs
annually in 400-1000 people per million, i.e. 15-20% of patients develop lower limb
ischemia.According to the World Health Organization, this figure will increase by 5%
in the next few years. CINC is the most severe manifestation of stenotic lesions of the
lower extremities.
The development of critical ischemia indicates a complete decompensation of
blood circulation and poses a serious danger not only to the patient's limb, but also to
his or her life.
The need for high amputation, i.e. above the knee joint, reaches 52-95% within 3
years and is accompanied by an overall mortality rate of 10-40% to 71% within the next
2 to 3 years.
In patients with diabetes with or without infected wounds, blood supply is restored
directly to the area with trophic changes. A significant problem remains the presence of
“multilevel” lesions of the lower extremity vessels, which is detected in 70% of patients
with critical ischemia.
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In the presence of diabetes mellitus, critical ischemia is observed about 5 times
more often. Trophic lesions develop in 10% of elderly patients with diabetes mellitus.
According to studies, in patients with lesions of one vascular pool, involvement of other
arterial pools occurs in 25-35.2 patients.
Diabetic foot syndrome is currently considered one of the most severe late
complications of diabetes. Diabetic foot ulcers, gangrene and amputation cause health
damage, significantly impair the quality of life of patients and are accompanied by
significant economic costs.
The presence of severe ischemia fundamentally changes the prognosis of
treatment of patients with diabetes: the probability of healing ulcerative defects without
restoring the main blood flow is only 10-30%. The progression of the lesion and the lack
of wound healing after small amputations in the setting of critical ischemia lead to the
need for high amputation in most patients. It is known that reconstructive interventions
on the arteries of the lower extremities in such cases radically change the prognosis of
treatment - it allows avoiding high amputation, and quite often amputation in general.
Traditionally used conservative therapy for obliterative atherosclerosis in the
stage of CINC, which includes anticoagulants, rheological drugs and angioprotectors, is
not effective enough and is accompanied by limb loss in 37% of patients within 1 year.
However, in practice, adequate revascularization of the arterial bed of the lower
extremities is possible in only 37.3 to 58 % of patients.
The effectiveness of conservative therapy of CINC in the setting of diabetes
mellitus is low - only in 40% of cases the limb can be preserved for six months, 20% of
patients die, and most patients, up to 95%, undergo high amputation.
In terms of the effectiveness of surgical treatment, the DFS is also quite low. This
is due to the multifactorial nature of the disease, which makes it difficult to control the
course of the wound process. Such patients require reconstruction of the main arterial
bleeding, but performing long-term open surgeries, especially with concomitant
pathologies such as diabetes, is associated with a high risk.
That is why, given the ineffectiveness of conservative therapy and the risk of open
surgery in patients with diabetes mellitus with CINC, the question of minimally
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traumatic methods of restoring arterial patency with high efficiency is increasingly being
raised. These conditions are met by balloon angioplasty and stenting of the peripheral
arteries of the lower extremities. In addition to low trauma, X-ray endovascular
operations are characterized by low mortality and complication rates, no need for a long
recovery period, and early activation of patients. It is also possible to perform multiple
surgeries or open surgery if necessary, and the absence of the need for general anesthesia
is especially important in certain comorbidities.
