Long-term results of proximal and distal reconstructions in patients with lower limb arteries diffuse lesions and diabetes mellitus

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Relevance . Treatment of diffuse lesions of the arteries of the lower extremities is often reduced to primary amputation at the hip level, since the healing of trophic ulcers is not guaranteed during arterial reconstruction. Profundoplasty without distal bypass surgery can be considered an alternative method. The aim of this study is to compare the long-term results of distal shunting and isolated profundoplasty in patients with diffuse lesions of the lower limb arteries and trophic ischemic ulcers. Materials and Methods . The study included 86 patients with diffuse lesions of the lower limb arteries. There were 52 (60.4%) men and 34 (39.6%) women. The average age was 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the pupar ligament, the state of the lower leg arteries was 5-8.5 points on the Rutherford scale, in all cases there were trophic ulcers. Group 1 included 48 patients who underwent reconstruction of the leg arteries. Group 2 consisted of 38 individuals who had limited intervention with endarcteriotomy from common femoral and deep femoral arteries. Results and Discussion . Amputations at the hip level were performed within a year in 11 (23.4%) patients of group 1 and in 3 (6.3%) patients within 30 days after surgery. Thus, 14 (29.7%) patients lost their limbs. A comparative analysis revealed that the group of patients with amputations had a more severe form of diabetes (p = 0.003), an outflow score on the Rutherford scale (p <0.001), and lower transcutaneous oxygen tension values before and after surgery. Within 12 months after the bypass surgery, the primary patency of the shunts was 65.9% (thrombosis occurred in 16 patients). Conclusion . The preservation of the limb in patients in our study by the end of 1 year after reconstruction is similar regardless of the reconstruction method. Given the minimal invasion during profundoplasty, this operation may be the method of choice for diffuse lesions of the arteries of the lower extremities.

About the authors

Leo A. Bockeria

Bakulev Scientific Center of Cardiovascular Surgery

Author for correspondence.
Email: ashihara@mail.ru
ORCID iD: 0000-0002-6180-2619
Moscow, Russian Federation

Valery S. Arakelyan

Bakulev Scientific Center of Cardiovascular Surgery

Email: ashihara@mail.ru
ORCID iD: 0000-0002-0284-6793
Moscow, Russian Federation

Vasil G. Papitashvili

Bakulev Scientific Center of Cardiovascular Surgery

Email: ashihara@mail.ru
ORCID iD: 0000-0001-9987-5410
Moscow, Russian Federation

Shalva Sh. Tsurtsumiya

Sechenov University

Email: ashihara@mail.ru
ORCID iD: 0000-0001-5538-7845
Moscow, Russian Federation


  1. Schwalb PG, Kalinin RE, Zhelezinsky VP. Amputation in acute obstruction of peripheral arteries. Questions of angiology of vascular and operative surgery. GOUVPO RyazGMU. 2005. P. 106—110. (In Russian).
  2. Tanaka Y, Uemura T, Ayabe S, Hirao T, Nagasao T. Revisiting Microsurgical Distal Bypass for Critical Limb Ischemia. J Reconstr Microsurg. 2016;32(8):608—614. doi: 10.1055/s-0036—1584514.
  3. Derksen WJ, Gisbertz SS, Hellings WE, Vink A, de Kleijn DP, de Vries JP, Moll FL, Pasterkamp G. Predictive risk factors for restenosis after remote superficial femoral artery endarterectomy. Eur J Vasc Endovasc Surg. 2010;39(5):597—603. doi: 10.1016/j. ejvs.2010.01.015.
  4. Mätzke S, Pitkänen J, Lepäntalo M. Does saphenous vein arterialization prevent major amputation in critical leg ischemia? J. Cardiovasc. Sur. 1999;6:845—847.
  5. Dibirov MD, Dibirov AA, Gadzhimuradov RU. Distal reconstructions in critical ischemia of the lower extremities in patients of older age groups. Surgery. 2009;1:49—52. (In Russian).
  6. Gavrilenko AB, Skrylev SI. Surgical treatment of patients with critical ischemia of the lower extremities with lesions of the arteries of the femoral-popliteal-tibial segment. Surgery. 2004;8:36—42. (In Russian).
  7. Feinglass J, Pearce WH, Martin GJ, Gibbs J, Cowper D, Sorensen M, Khuri S, Daley J, Henderson WG. Postoperative and amputation-free survival outcomes after femorodistal bypass grafting surgery: findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. J Vasc Surg. 2001;34(2):283— 90. doi: 10.1067/mva.2001.116807.
  8. Slim H, Tiwari A, Ahmed A, Ritter JC, Zayed H, Rashid H. Distal versus ultradistal bypass grafts: amputation-free survival and patency rates in patients with critical leg ischaemia. Eur J Vasc Endovasc Surg. 2011;42(1):83—8. doi: 10.1016/j.ejvs.2011.03.016.
  9. Rashid H, Slim H, Zayed H, Huang DY, Wilkins CJ, Evans DR, Sidhu PS, Edmonds M. The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome. J Vasc Surg. 2013;57(5):1219—26. doi: 10.1016/j.jvs.2012.10.129.
  10. Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S-293S. doi: 10.1097/01. prs.0000222582.84385.54.
  11. Brochado-Neto FC, Albers M, Romiti M. The distal zone of the deep femoral artery as the inflow site in femorodistal bypass grafting. Eur J Vasc Endovasc Surg. 2006;31:407e9.
  12. Witz M, Shnacker A, Lehmann JM. Isolated femoral profundoplasty using endarterectomised superficial femoral artery for limb salvage in the elderly. Minerva Cardioangiol. 2000;48(12):451—4. PMID: 11253330.
  13. Khalifa AA, Gueret G, Badra A, Gouny P. Diabetic critical ischemia of lower limbs: distal arterial revascularisation. Acta Chir Belg. 2009;109(3):321—6. doi: 10.1080/00015458.2009.11680433.
  14. Apelqvist J, Elgzyri T, Larsson J, Löndahl M, Nyberg P, Thörne J. Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. J Vasc Surg. 2011;53(6):1582—8.e2. doi: 10.1016/j.jvs.2011.02.006.
  15. Urabe G, Yamamoto K, Onozuka A, Miyata T, Nagawa H. Skin Perfusion Pressure is a Useful Tool for Evaluating Outcome of Ischemic Foot Ulcers with Conservative Therapy. Ann Vasc Dis. 2009;2(1):21—6. doi: 10.3400/avd.AVDoa08029.

Copyright (c) 2021 Bockeria L.A., Arakelyan V.S., Papitashvili V.G., Tsurtsumiya S.S.

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