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
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 



