Complications associated with the treatment of chronic limb-threatening ischemia
DOI:
https://doi.org/10.14739/2310-1210.2023.4.277338Keywords:
chronic limb-threatening ischemia, atherosclerosis, surgical site infection, pseudoaneurysmAbstract
The aim of the work is to review current national and foreign specialized literature on various complications associated with the treatment of chronic limb-threatening ischemia.
Atherosclerotic lesion of the lower limb arteries is the most common cause of tissue perfusion deficiency of the lower limbs and can lead to their loss. A radical method of treatment for chronic limb-threatening ischemia (CLTI) remains revascularization. Despite the modern possibilities of surgical treatment and many years of experience in such treatment, the percentage of surgical complications is still substantial.
The level of providing qualitative care to patients with CLTI consists in the successful correction of the mentioned complications. That is why the analysis of this problem is an urgent issue of modern angiosurgery.
Conclusions. Most complications after surgical treatment of atherosclerotic lower limb lesions could cause both a limb loss and a severe systemic disorder development in general. The presented data of the professional literature review of clinical and experimental studies justify the need for an early management of complications associated with surgical treatment of chronic limb-threatening ischemia. It would contribute not only to the limb preservation, but also prevent the occurrence of severe general somatic complications.
References
Farber, A., Menard, M. T., Conte, M. S., Kaufman, J. A., Powell, R. J., Choudhry, N. K., Rosenfield, K. (2022). Surgery or endovascular therapy for chronic limb-threatening ischemia. New England Journal of Medicine, 387(25), 2305-2316. https://doi.org/10.1056/nejmoa2207899
Nikishyn, O. L., Palamarchuk, V. I., Shcheglov, D. V., & Vereschagyn, S. V. (2014). Renthenendovaskuliarne likuvannia khvorykh z krytychnoiu ishemiieiu nyzhnikh kintsivok [Roentgenendovascular treatment of critical limb ischemia]. Zbirnyk naukovykh prats spivrobitnykiv NMAPO, 23(4), 107-113. [in Ukrainian].
Jaff, M. R., White, C. J., Hiatt, W. R., Fowkes, G. R., Dormandy, J., Razavi, M., Reekers, J., & Norgren, L. (2015). An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II): The TASC Steering Comittee(.). Annals of vascular diseases, 8(4), 343-357. https://doi.org/10.3400/avd.tasc.15-01000
Shaprynskyi, V., Gupalo, Y., Shved, O., Nabolotnyi, O., & Shapovalov, D. (2018). Likuvannia krytychnoi ishemii nyzhnikh kintsivok u patsiientiv iz bahatopoverkhovymy urazhenniamy arterialnoho rusla [Treatment of critical limb ischemia in patients with multilevel arterial lesions]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu, 22(3), 474-478. https://doi.org/10.31393/reports-vnmedical-2018-22(3)-16
Prasol, V. A., Miasoiedov, K. V., & Shaprynsky, V. V. (2020). Dotsilnist vykorystannia tsylostazolu u khvorykh iz khronichnoiu zahrozlyvoiu ishemiieiu nyzhnikh kintsivok [Advisability of using cilostazol in patients with chronic limb-threatening ischemia]. Art of Medicine. (4), 108-113. [in Ukrainian].
Setacci, C., De Donato, G., Setacci, F., & Chisci, E. (2010). Ischemic foot: definition, etiology and angiosome concept. The Journal of cardiovascular surgery, 51(2), 223-231.
Acín, F., Varela, C., López de Maturana, I., de Haro, J., Bleda, S., & Rodriguez-Padilla, J. (2014). Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome-oriented revascularization strategy. International journal of vascular medicine, 2014, 270539. https://doi.org/10.1155/2014/270539
Cherniak, V. A. (2013). Khirurhichne likuvannia krytychnoi ishemii nyzhnikh kintsivok [Surgery of critical ischemia of the lower extremities]. Sertse i sudyny, (1), 54-63. [in Ukrainian].
Mii, S., Tanaka, K., Kyuragi, R., Ishimura, H., Yasukawa, S., Guntani, A., & Kawakubo, E. (2017). Aggressive Wound Care by a Multidisciplinary Team Improves Wound Healing after Infrainguinal Bypass in Patients with Critical Limb Ischemia. Annals of vascular surgery, 41, 196–204. https://doi.org/10.1016/j.avsg.2016.09.024
Geskin, G., Mulock, M. D., Tomko, N. L., Dasta, A., & Gopalakrishnan, S. (2022). Effects of Lower Limb Revascularization on the Microcirculation of the Foot: A Retrospective Cohort Study. Diagnostics (Basel, Switzerland), 12(6), 1320. https://doi.org/10.3390/diagnostics12061320
Almasri, J., Adusumalli, J., Asi, N., Lakis, S., Alsawas, M., Prokop, L. J., Bradbury, A., Kolh, P., Conte, M. S., & Murad, M. H. (2018). A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. Journal of vascular surgery, 68(2), 624-633. https://doi.org/10.1016/j.jvs.2018.01.066
Karimi, A., Lauria, A. L., Aryavand, B., & Neville, R. F. (2022). Novel Therapies for Critical Limb-Threatening Ischemia. Current cardiology reports, 24(5), 513-517. https://doi.org/10.1007/s11886-022-01669-6
Rusyn, V. I., Korsak, V. V., Popovych, Y. M., Rusyn, V. V., & Chobei, S. M. (2012). Vybir metodu khirurhichnoho vtruchannia pry okliuziino-stenotychnykh urazhenniakh arterii nyzhnikh kintsivok [Choice of surgical intervention at arterial occlusion-stenotic lesions of the lower extremities]. Naukovyi visnyk Uzhhorodskoho universytetu. Seriia "Medytsyna", (3), 98-101. [in Ukrainian].
Armstrong, E. J. (2017). Endovascular Treatment of Peripheral Artery Disease and Critical We of j Ischemia. Interventional cardiology clinics, 6(2). https://doi.org/10.1016/j.iccl.2017.01.001
Patel, S. D., Biasi, L., Paraskevopoulos, I., Silickas, J., Lea, T., Diamantopoulos, A., Katsanos, K., & Zayed, H. (2016). Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease. The British journal of surgery, 103(13), 1815-1822. https://doi.org/10.1002/bjs.10292
Arvela, E., Venermo, M., Söderström, M., Albäck, A., & Lepäntalo, M. (2012). Outcome of infrainguinal single-segment great saphenous vein bypass for critical limb ischemia is superior to alternative autologous vein bypass, especially in patients with high operative risk. Annals of vascular surgery, 26(3), 396-403. https://doi.org/10.1016/j.avsg.2011.08.013
Thermann, F. (2018). Creation of an Arterialized Cephalic Vein as Autologous Bypass for Below-Knee Reconstruction in Critical Limb Ischemia. Annals of vascular surgery, 49, 317.e1-317.e3. https://doi.org/10.1016/j.avsg.2017.12.019
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J. B., Suresh, K. R., Murad, M. H., & GVG Writing Group (2019). Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of vascular surgery, 69(6S), 3S-125S.e40. https://doi.org/10.1016/j.jvs.2019.02.016
Lee, K. B., Macsata, R. A., Lala, S., Sparks, A. D., Amdur, R. L., Ricotta, J. J., Sidawy, A. N., & Nguyen, B. N. (2021). Outcomes of open and endovascular interventions in patients with chronic limb threatening ischemia. Vascular, 29(5), 693-703. https://doi.org/10.1177/1708538120971972
Pecoraro, F., Pakeliani, D., Bruno, S., Dinoto, E., Ferlito, F., Mirabella, D., Lachat, M., Cudia, B., & Bajardi, G. (2021). Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia. Journal of clinical medicine, 10(13), 2865. https://doi.org/10.3390/jcm10132865
Dayama, A., Tsilimparis, N., Kolakowski, S., Matolo, N. M., & Humphries, M. D. (2019). Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease. Journal of vascular surgery, 69(1), 156-163.e1. https://doi.org/10.1016/j.jvs.2018.05.244
Serna Santos, J., Söderström, M., Helminen, R., Aho, P., Halmesmäki, K., & Venermo, M. (2021). Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia. Scandinavian journal of surgery, 110(2), 241-247. https://doi.org/10.1177/1457496920975608
Kehlet, M., Jensen, L. P., & Schroeder, T. V. (2016). Risk Factors for Complications after Peripheral Vascular Surgery in 3,202 Patient Procedures. Annals of vascular surgery, 36, 13-21. https://doi.org/10.1016/j.avsg.2016.02.028
Furuyama, T., Onohara, T., Yamashita, S., Yoshiga, R., Yoshiya, K., Inoue, K., Morisaki, K., Kyuragi, R., Matsumoto, T., & Maehara, Y. (2018). Prognostic factors of ulcer healing and amputation-free survival in patients with critical limb ischemia. Vascular, 26(6), 626-633. https://doi.org/10.1177/1708538118786864
Stewart, L. M., Spangler, E. L., Sutzko, D. C., Pearce, B. J., McFarland, G. E., Passman, M. A., Patterson, M. A., Haverstock, B., Unger, K., Novak, Z., & Beck, A. W. (2021). The association between preoperative length of stay and surgical site infection after lower extremity bypass for chronic limb-threatening ischemia. Journal of vascular surgery, 73(4), 1340-1349.e2. https://doi.org/10.1016/j.jvs.2020.08.037
Matano, F., Murai, Y., Sato, S., Koketsu, K., Shirokane, K., Ishisaka, E., Tsukiyama, A., & Morita, A. (2020). Risk factors for ischemic complications in vascular reconstructive surgeries. Clinical neurology and neurosurgery, 193, 105768. https://doi.org/10.1016/j.clineuro.2020.105768
Eldrup, N., Cerqueira, C., de la Motte, L., Rathenborg, L. K., & Hansen, A. K. (2016). The Danish Vascular Registry, Karbase. Clinical epidemiology, 8, 713-718. https://doi.org/10.2147/CLEP.S99506
Tyndall, S. H., Shepard, A. D., Wilczewski, J. M., Reddy, D. J., Elliott, J. P., Jr, & Ernst, C. B. (1994). Groin lymphatic complications after arterial reconstruction. Journal of vascular surgery, 19(5), 858-864. https://doi.org/10.1016/s0741-5214(94)70011-7
Street, T. (2015). Postoperative Groin Wound Complications. Journal of Vascular Nursing, 33(2), 82. https://doi.org/10.1016/j.jvn.2015.05.004
East, S. A., Lorenz, R. A., & Armbrecht, E. S. (2013). A retrospective review of leg wound complications after coronary artery bypass surgery. AORN journal, 98(4), 401-412. https://doi.org/10.1016/j.aorn.2013.07.016
Price, A., Contractor, U., White, R., & Williams, I. (2020). The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin. International wound journal, 17(6), 1669-1677. https://doi.org/10.1111/iwj.13449
Greenblatt, D. Y., Rajamanickam, V., & Mell, M. W. (2011). Predictors of surgical site infection after open lower extremity revascularization. Journal of vascular surgery, 54(2), 433-439. https://doi.org/10.1016/j.jvs.2011.01.034
Zamani, N., Sharath, S. E., Vo, E., Awad, S. S., Kougias, P., & Barshes, N. R. (2018). A Multi-Component Strategy to Decrease Wound Complications after Open Infra-Inguinal Re-Vascularization. Surgical infections, 19(1), 87-94. https://doi.org/10.1089/sur.2017.193
Sandmann W. (2016). How to Avoid Lymphatic Wound Complications After Vascular Groin Surgery. European journal of vascular and endovascular surgery, 52(2), 263. https://doi.org/10.1016/j.ejvs.2016.04.026
Thorup, C. B., Hougaard, M., Blindum, P. F., & Sørensen, E. E. (2018). Hospitalised patients' experiences during Negative Pressure Wound Therapy due to surgical site infection after vascular and cardiac surgery. International wound journal, 15(5), 707-716. https://doi.org/10.1111/iwj.12913
Audu, C. O., Columbo, J. A., Sun, S. J., Perri, J. L., Goodney, P. P., Stone, D. H., Nolan, B. W., & Suckow, B. D. (2019). Variation in timing and type of groin wound complications highlights the need for uniform reporting standards. Journal of vascular surgery, 69(2), 532-543. https://doi.org/10.1016/j.jvs.2018.05.221
Banerjee, S. (2017). Practical approach to peripheral arterial chronic total occlusions. Practical Approach to Peripheral Arterial Chronic Total Occlusions (pp. 1-303). Springer Singapore. https://doi.org/10.1007/978-981-10-3053-6
Pleger, S. P., Nink, N., Elzien, M., Kunold, A., Koshty, A., & Böning, A. (2018). Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. International wound journal, 15(1), 75-83. https://doi.org/10.1111/iwj.12836
Groin wound Infection after Vascular Exposure (GIVE) Study Group (2021). Groin wound infection after vascular exposure (GIVE) multicentre cohort study. International wound journal, 18(2), 164-175. https://doi.org/10.1111/iwj.13508
Kolasiński, W. (2018). Surgical site infections - review of current knowledge, methods of prevention. Polski przeglad chirurgiczny, 91(4), 41-47. https://doi.org/10.5604/01.3001.0012.7253
Andersson, S., Monsen, C., & Acosta, S. (2018). Outcome and Complications Using Negative Pressure Wound Therapy in the Groin for Perivascular Surgical Site Infections after Vascular Surgery. Annals of vascular surgery, 48, 104-110. https://doi.org/10.1016/j.avsg.2017.10.018
Inui, T., & Bandyk, D. F. (2015). Vascular surgical site infection: risk factors and preventive measures. Seminars in vascular surgery, 28(3-4), 201-207. https://doi.org/10.1053/j.semvascsurg.2016.02.002
Gwilym, B. L., Dovell, G., Dattani, N., Ambler, G. K., Shalhoub, J., Forsythe, R. O., Benson, R. A., Nandhra, S., Preece, R., Onida, S., Hitchman, L., Coughlin, P., Saratzis, A., & Bosanquet, D. C. (2021). Editor's Choice - Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery. European journal of vascular and endovascular surgery, 61(4), 636-646. https://doi.org/10.1016/j.ejvs.2020.11.053
Takahashi, W., Morita, T., Tanaka, K., Ide, S., & Hujimori, K. (2021). Challenging endovascular treatment for the patient with chronic limb threatening ischemia due to antiphospholipid syndrome. Journal of cardiology cases, 24(6), 276-279. https://doi.org/10.1016/j.jccase.2021.04.021
Arnold, M. J., Keung, J. J., & McCarragher, B. (2019). Interventional Radiology: Indications and Best Practices. American family physician, 99(9), 547-556.
Stone, P. A., Campbell, J. E., & AbuRahma, A. F. (2014). Femoral pseudoaneurysms after percutaneous access. Journal of vascular surgery, 60(5), 1359-1366. https://doi.org/10.1016/j.jvs.2014.07.035
Dzijan-Horn, M., Langwieser, N., Groha, P., Bradaric, C., Linhardt, M., Böttiger, C., Byrne, R. A., Steppich, B., Koppara, T., Gödel, J., Hadamitzky, M., Ott, I., von Beckerath, N., Kastrati, A., Laugwitz, K. L., & Ibrahim, T. (2014). Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circulation. Cardiovascular interventions, 7(2), 207-215. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000836
Stolt, M., Braun-Dullaeus, R., & Herold, J. (2018). Do not underestimate the femoral pseudoaneurysm. VASA. Zeitschrift fur Gefasskrankheiten, 47(3), 177-185. https://doi.org/10.1024/0301-1526/a000691
Gwilym, B. L., Locker, D. T., Matthews, E. K., Mazumdar, E., Adamson, G., Wall, M. L., & Bosanquet, D. C. (2023). Systematic review of groin wound surgical site infection incidence after arterial intervention. International wound journal, 20(4), 1276-1291. https://doi.org/10.1111/iwj.13959
Sarioglu, O., Capar, A. E., & Belet, U. (2019). Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Polish journal of radiology, 84, e319-e327. https://doi.org/10.5114/pjr.2019.88021
Kurzawski, J., Sadowski, M., & Janion-Sadowska, A. (2016). Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm. Journal of clinical ultrasound : JCU, 44(3), 188-195. https://doi.org/10.1002/jcu.22274
Muglia, R., Marra, P., Dulcetta, L., Carbone, F. S., Bonaffini, P. A., & Sironi, S. (2023). US-guided percutaneous thrombin injection to treat non-femoral artery pseudoaneurysms: preliminary experience and review of the literature. La Radiologia medica, 128(1), 125-131. https://doi.org/10.1007/s11547-022-01576-4
Sirignano, P., Citone, M., Menna, D., Mansour, W., Montelione, N., Capoccia, L., & Speziale, F. (2015). Superficial Femoral Artery Stent Disruption Treated by Peripheral Endograft. Annals of vascular surgery, 29(8). https://doi.org/10.1016/j.avsg.2015.06.085
Jeon, Y. S., Kim, J. Y., & Cho, S. G. (2012). Percutaneous treatment of a femoral artery pseudoaneurysm using the StarClose vascular closure system. Catheterization and cardiovascular interventions, 80(5), 872-875. https://doi.org/10.1002/ccd.23230
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