Novosti
|
This journal is indexed in Scopus |
|---|
Year 2020 Vol. 28 No 5
GENERAL & SPECIAL SURGERY
S.Y.GOROKHOVSKY 1, 2, A.A. LYZIKOV 1, M.L. KAPLAN 1, V.E. TIHMANOVICH 1
EXPEDIENCY AND OPTIONS FOR FUNCTIONAL CONTROL IN DETERMINING THE EXTENT OF SURGERY FOR OCCLUSIVE LESIONS OF THE LOWER EXTREMITY ARTERIES
Gomel State Medical University 1,
Gomel Regional Clinical Cardiology Center 2, Gomel,
Republic of Belarus
Objectives. To analyze and assess the efficiency of different strategies of the endovascular revascularization in patients with multilevel affection of lower extremity peripheral arteries based on angiographic and functional criteria.
Methods. The patients (n=114) with chronict multilevel of chronic lower extremity peripheral arteries were included in the study. The first group (n=60) comprised patients who underwent revascularization based on the angiographic criteria; the second one (n=40) included patients in whom the surgery was performed under both angiographic control and invasive intraoperative hemodynamic monitoring of the peripheral circulation; patients of the third group (n=14) were operated on the basis of peripheral fraction blood flow reserve (pFFR) determination in addition to the conventional angiography. Surgery results were assessed depending on value of ankle-brachial index (ABI); to compare the volume of intervention the estimated coefficient of revascularization was expressed as the ratio of the number of the treated segments to the number of affected ones.
Results. In all groups, the performed treatment resulted in the statistically significant (p<0,05) changes of ABI which was the evidence of therapy effectiveness. In the study groups ABI values after the operation amounted 0,8 (0,75; 0,8), 0,9 (0,8; 1) and 0,9 (0,9; 1), respectively, which is associated with a satisfactory result of treatment and prognosis of the disease. The given results were achieved in the presence of the statistically significant difference between groups in length of segments underwent angioplasty (mm) –170 (120; 200), 100 (80; 120) and 130 (115; 155), p=0,00007, stented segment length (mm)– 100 (60; 145), 60 (40; 100), 40 (30;40), р=0,00063 and revascularization coefficient: 1 (0,67; 1), 0,5 (0,5; 0,66) and 0,5 (0,5; 0,575), p<0,0001.
Conclusion. Methods of invasive functional assessment of the peripheral circulation in addition to the angiographic criteria allow reducing the volume of intervention with an optimal clinical result.
- Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, Camici PG, Cerqueira MD, Chow BJW, Di Carli MF, Dorbala S, Gewirtz H, Gropler RJ, Kaufmann PA, Knaapen P, Knuuti J, Merhige ME, Rentrop KP, Ruddy TD, Schelbert HR, Schindler TH, Schwaiger M, Sdringola S, Vitarello J, Williams KA Sr, Gordon D, Dilsizian V, Narula J. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol. 2013 Oct 29;62(18):1639-53. doi: 10.1016/j.jacc.2013.07.076
- Lotfi A, Jeremias A, Fearon WF, Feldman MD, Mehran R, Messenger JC, Grines CL, Dean LS, Kern MJ, Klein LW; Society of Cardiovascular Angiography and Interventions. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the Society of Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2014 Mar 1;83(4):509-18. doi: 10.1002/ccd.25222
- van de Hoef TP, Meuwissen M, Escaned J, Davies JE, Siebes M, Spaan JA, Piek JJ. Fractional flow reserve as a surrogate for inducible myocardial ischaemia. Nat Rev Cardiol. 2013 Aug;10(8):439-52. doi: 10.1038/nrcardio.2013.86
- Xaplanteris P, Fournier S, Pijls NHJ, Fearon WF, Barbato E, Tonino PAL, Engstrøm T, Kääb S, Dambrink JH, Rioufol G, Toth GG, Piroth Z, Witt N, Fröbert O, Kala P, Linke A, Jagic N, Mates M, Mavromatis K, Samady H, Irimpen A, Oldroyd K, Campo G, Rothenbühler M, Jüni P, De Bruyne B; FAME 2 Investigators. Five-year outcomes with pci guided by fractional flow reserve. N Engl J Med. 2018 Jul 19;379(3):250-59. doi: 10.1056/NEJMoa1803538
- Pijls NH, Klauss V, Siebert U, Powers E, Takazawa K, Fearon WF, Escaned J, Tsurumi Y, Akasaka T, Samady H, De Bruyne B. Fractional Flow Reserve (FFR) Post-Stent Registry Investigators. Coronary pressure measurement after stenting predicts adverse events at follow-up: a multicenter registry. Circulation. 2002 Jun 25;105(25):2950-54. doi: 10.1161/01.cir.0000020547.92091.76
- Murata N, Aihara H, Soga Y, Tomoi Y, Hiramori S, Kobayashi Y, Ichihashi K, Tanaka N. Validation of pressure gradient and peripheral fractional flow reserve measured by a pressure wire for diagnosis of iliofemoral artery disease with intermediate stenosis. Med Devices (Auckl). 2015;8:467-72. Published online 2015 Nov 9. doi: 10.2147/MDER.S83768
- Banerjee S, Badhey N, Lichtenwalter C, Varghese C, Brilakis ES. Relationship of walking impairment and ankle-brachial index assessments with peripheral arterial translesional pressure gradients. J Invasive Cardiol. 2011 Sep;23(9):352-56. https://www.invasivecardiology.com/content/volume-23-issue-9-september-2011?page=1
- Ruzsa Z, Róna S, Tóth GG, Sótonyi P, Bertrand OF, Nemes B, Merkely B, Hüttl K. Fractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes. Cardiovasc Revasc Med. 2018 Mar;19(2):175-81. doi: 10.1016/j.carrev.2017.07.007
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007 Jan;45(Suppl S):S5-67. doi: 10.1016/j.jvs.2006.12.037
- Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO) the task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1;39(9):763-16. doi: 10.1093/eurheartj/ehx095
- Maeda A, Tashiro K, Sasai M, Mori H, Sato T, Hayashi M, Suzuki H. Safety and efficacy of Adenosine 5’-Triphosphate as a hyperemic agent for the assessment of peripheral fractional flow reserve. Showa Univ J Med Sci. 2018;30(2):151-58. doi: 10.15369/sujms.30.151
246046, Republic of Belarus,
Gomel, Meditsinskaya str., 4,
Gomel State Medical University,
Department of Surgical Diseases No1,
Tel./fax: +375 232 49-19-54
e-mail: surgery_1@gsmu.by
Gorokhovsky Sergey Yu.
Lyzikov Alexey A., MD, Professor, Head of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-0639-121X
Gorokhovsky Sergey Yu., Roentgen-Endovascular Surgeon, Head of the Interventional Radiology Ward, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0596-1391
Kaplan Mark L., PhD, Associate Professor of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-7782-3281
Tihmanovich Victor E., Assistant Lecturer of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-3486-9113
Article in the .pdf format
