Makivchuk D. Minimally Invasive Treatment of Lower Limb Arterial Thrombosis.

The dissertation analyzes the results of treatment in patients with thrombosis of the lower limb arteries involving the outflow arteries, with particular emphasis on the use of thrombolytic therapy. Aim of the study: to improve the effectiveness of treatment for patients with acute lower limb thrombosis involving the outflow arteries by optimizing minimally invasive methods of revascularization, in particular CDT across different nosological variants of the disease. The study included 82 patients with acute thrombosis of the lower limb arteries involving damage to the outflow arteries, resulting in acute lower limb ischemia (ALLI). Patients were divided into groups according to the the study design: prospective (main group) and retrospective (comparison group). Patients in the comparison group underwent open, hybrid and endovascular interventions, in particular thrombolytic therapy using streptokinase or urokinase. Currently, thrombolytic agents containing recombinant tissue plasminogen activator II (Alteplase) are available in Ukraine, therefore patients who received treatment using the above-mentioned drug were assigned to the prospective group. Accordingly, 42 (51.2%) patients in the main group underwent endovascular interventions that were either supplemented with thrombolytic therapy or consisted of its application. Intragroup distribution according to the nosological cause of thrombosis were as follows: 24 (57.1%) patients with steno-occlusive disease lower limb arteries, 4 (9.5%) patients with nonspecific inflammatory lower limb arterial disease, 9 (21.4%) patients with thromboembolism of the lower limb arteries, 5 (11.9%) patients with intraprocedural arterial lower limb thrombosis. The subgroup of intraprocedural thrombosis included the results of treatment for patients with steno-occlusive lesions in whom thrombosis developed during endovascular intervention, which required subsequent thrombolytic therapy to achieve lower limb revascularization and restore patency of the outflow arteries. The comparison group included patients from a retrospective cohort, totaling 40 (48.8%) cases. The mean age of the patients was 59.0±17.7 years. The gender distribution was 28 (70%) men and 12 (30%) women. Primary hospitalization with a diagnosis of ALLI on the background of ALLAT involving the damaged outflow arteries was observed in 34 (85%) patients. Secondary hospitalization due to retrothrombosis of the reconstructed segment (following primary intervention in another medical facility) in 6 (15%) patients. In the comparison group, the aintragroup distribution according to the nosological cause of thrombosis was as follows: 17 (42.5%) patients with steno-occlusive disease of the lower limb arteries, 15 (37.5%) patients with thromboangiitis obliterans of the lower limb, 8 (20%) patients with popliteal artery aneurysm. Analysis of the treatment outcomes demonstrated that among patients who underwent open surgical interventions (n = 17), rethrombosis occurred in 10 (58.8%) patients (p = 0.037), while 6 (35.3%) patients required amputation (p = 0.017). Accordingly, the relative risk of amputation in patients who underwent open surgical interventions is significantly higher , at RR = 4.127. In the subgroup of patients with lower limb arterial thrombosis caused by nonspecific inflammatory arterial disease (n = 15) no cases of rethrombosis of the reconstructed segment were recorder during CDT (p=0.009) and the lower limb preservation was achieved in 100% of cases. Among 40 patients who underwent CDT as a monomethod or as part of a combined endovascular intervention, rethrombosis was observed in 11 (26%) patients, a statistically significant difference in the frequency of rethrombosis was noted compared with the groups that underwent endovascular and open interventions (p=0.025). In addition, preservation of the lower limb was achieved in 40 (93%) patients (p=0.035). The results of this study demonstrated that in patients with lower limb arterial thrombosis involving the outflow arteries, who did not undergo X-ray control of the reconstruction zone, the risk of rethrombosis was associated with a 2.127-fold increase and a 4.127-fold increase in the risk of amputation.