Chevgun S.D., Abdyldaev I.Z., Imankulova A. S., Bebezov I.H., Cholponbaev D. Ch., Nurbekov K.N., Daniyarov B.S., Raimkulov A.E., Alekseev D.N., Eginaliev A. Osmonov T.A.
Objective: Pure atherosclerosis and diabetes mellitus are often responsible for the lesion of lower limb arteries. As a result, critical ischemia may develop. Endovascular treatment of lower extremities chronic ischemia in the modern world one of the most effective methods of limbs salvage. This report is an analysis of the first experience of endovascular treatment in consecutive patients with chronic lower limb ischemia in the Kyrgyz Republic.
Methods: In 2016-2018, there were 31 patients with chronic lower limb ischemia in IIb-IV Fontaine's stages who underwent endovascular treatment. The primary endpoint was 6-month painlessness or reduction of the Fontaine stage; freedom from amputation up to six months; active regenerative process or full recovery of ulcers/wounds up to six months. The secondary endpoints included 6-month all-cause mortality and reintervention rate.
Results: Overall, 27 (87.1%) patients reached painless form (stage I according to Fontaine (ABI ≥0.9)), with complete regeneration or active reparative process observed in 20 (64. 5%) patients. In general, major amputation was avoided in 29 (93.5%) patients (two patients underwent amputation by E. Burgess). Minor amputations were performed below the level of foot dorsum (Sharp) in 35.5% (11 patients). Simultaneous percutaneous coronary interventions and peripheral interventions were performed in 6 (19. 4%) cases. In total, within 6 months one death was registered (3.2%).
Conclusion: The first endovascular treatment of consecutive patients showed encouraging 6-month results. Simultaneous («Ad-hoc») or stepwise (at the current hospitalization) procedures on coronary and peripheral arteries ensure safety and can provide more chances of patient`s survival.
Key words: chronic lower limb ischemia, сritical limb ischemia, percutaneous coronary interventions, limb salvage, freedom from amputation.
Chevgun S.D., Abdyldaev I.Z., Daniyarov B.S., Bebezov I.H., Badrakly E.F., Osmonov T.A.
Objective: Coronary artery disease (CAD) remains the leading cause of premature death. Clinical management of patients with such disorders as acute coronary syndrome (ACS) is still one of the most important and debated issues in modern medicine. Some patients fail to come on the most relevant and recommended time for percutaneous coronary interventions (PCI) to receive an effective treatment. This study analyzed the results of the practical approach to the “compelled” delayed percutaneous coronary interventions (DPCI) in patients with acute coronary syndrome.
Methods: The study was performed retrospectively. From 2013 to 2016, there were 141 patients with CAD. The DPCI group with an average admission time when symptoms onset counts 89.4±17.5 hours was compared with the groups with medical therapy only (MT) and PCI after stabilization (PPCI).
Results: The revascularization Index in DPCI was 0.90±0.18 and in PPCI made 0.89±0.2 (p˃0.05). The percentage of ST segment recovery in the DPCI was 72.8% in patients with elevation, and 87% with ST segment depression. At the same time in comparison with the medical therapy group, a significant difference was found according to this criterion (45.2% and 67.2%, respectively) (p˂0.05). There were marked changes in DPCI in the data of the echocardiogram due to the reduction in the size of the left ventricle after delayed PCI. The main role in increasing the ejection fraction in DPCI group was the contraction of the left ventricle cavity during the end of systolic phase. In DPCI group 39 convalescents (92.9%) reached condition stabilization. All-cause mortality during hospitalization in the DPCI was noted for 3 patients (7.1%) and 9 patients (18%) in the MT (p˂0.05). The PPCI group had no lethal cases.
Conclusion: Delayed PCI in patients with ACS is safe and effective procedure. The use of delayed PCI in combination with optimal drug therapy is the most appropriate non-surgical method of myocardial revascularization in the studied cohort of patients. Delayed PCI results showed greater efficacy in the dynamics of the clinical and functional patient’s status compared to PCI performed after ACS stabilization.
Key words: delayed percutaneous coronary interventions, acute coronary syndrome, coronary artery disease.