Angiographic characteristics of the lesion, influencing the choice to perform either direct or indirect endovascular revascularization for critical ischaemia of the lower limbs

Kaputin M.Yu.^1,2, Platonov S.A.¹, Ovcharenko D.V.¹, Voronkov A.A.¹, Kiselev M.A.¹

1) St. Petersburg Scientific Research Institute for Emergency Ambulance Care named after I.I. Dzhanelidze, St. Petersburg, Russia
2) North-West State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

Objective: to determine which angiographic characteristics of a lesion of lower limb arteries are independent predictors of the possibility to re-establish the direct blood flow along the angiosomic (in relation to the trophic defect) artery.

Materials and methods: we carried out a retrospective analysis of angiograms of 192 patients with degree IV peripheral arterial disease according to A.V. Pokrovky’s classification, with restored free blood flow to the foot at least along one femoral artery by means of balloon angioplasty. All patients were subdivided into two groups: the group of direct revascularization (84 patients) and the group of indirect revascularization (108 patients). The compared groups reliably did not differ by the clinical characteristics and the stage of the trophic lesion (male gender, prevalence of diabetes mellitus and mean age amounted to: 45%, 73% and 71 years versus 39%, 77% and 69 years, respectively). However, in the group of direct revascularization more frequently were encountered lesions of the toes (75% vs 55%, p=0.005), while in the group of indirect revascularization prevailing were lesions of the heel region (7% vs 29%, p=0.0002).

Results: the statistical analysis showed that independent predictors for a possibility of performing direct revascularization were as follows: total occlusion of the angiosomic artery on the foot (risk ratio (95% CI) = 0.10 (0.03-0.31), p=0.0001), blind (without stump) occlusion in the site of the origin of the angiosomic artery on the crus or foot (risk ratio (95% CI)=0.41 (0.19-0.90, p=0.03), and total occlusion of the trifurcation of the popliteal artery (risk ratio (95% CI) = 028 (0.09-0.81), p=0.02). Conclusions: in the presence of the above enumerated angiographic characteristics of the lesions of lower limb arteries it is appropriate to initially consider a possibility of performing indirect revascularization.

KEY WORDS: lower limb critical ischaemia, angiosomes, balloon angioplasty.

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