Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Combined Endovascular Treatment of Acute Coronary Syndrome with Bioresorbable Scaffolds and Angioplasty in Patient with Critical Lower Limb Ischemia – Hybrid Treatment in Multidisciplinary Hospital

https://doi.org/10.20996/1819-6446-2018-14-6-901-907

Full Text:

Abstract

The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

About the Authors

A. I. Zagorulko
People's Friendship University of Russia (RUDN University)
Russian Federation
MD, Assistant, Chair of cardiology, endovascular and hybrid methods of diagnosis and treatment


R. V. Kolosov
People's Friendship University of Russia (RUDN University)
Russian Federation
MD, PhD, cardiovascular surgeon


A. V. Sidelnikov
People's Friendship University of Russia (RUDN University)
Russian Federation
MD, PhD, doctor in endovascular diagnosis and treatment


Yu. V. Korzheva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
7th year student


A. G. Koledinsky
People's Friendship University of Russia (RUDN University)
Russian Federation
MD, PhD, Head of Chair of cardiology, endovascular and hybrid methods of diagnosis and treatment


References

1. Topchyan I., Sidelnikov A., Zagorulko A. et al. Multivessel lesson in patients with acute coronary syndrome:choice of revascularization tactics. Bulletin of Postgraduate Medical Education. 2017;4:104-5 (In Russ.)

2. Ishibashi Y., Onuma Y., Muramatsu T. et al. Lessons Learned from acute and late scaffold failures in the Absorb Extend trial. EuroIntervention. 2014;10(4):449-57. doi:10.4244/EIJV10I4A78.

3. Woudstra P., Grundeken M.J., Kraak R.P. et al. Amsterdam Investigator-initiate D Absorb strategy allcomers trial (AIDA trial). A clinical evaluation comparing the efficacy and performance of Absorb everolimus-eluting bioresorbable vascular scaffold strategy vs the Xience family (Xience Prime or Xience Xpedition) everolimus-eluting coronary stent strategy in the treatment of coronary lesions in consecutive all-comers: Rationale and study design. Am Heart J. 2014;167(2):133-40. doi:10.1016/j.ahj.2013.09.017.

4. European Working Group on Chonic Critical Leg Ischemia. Second European Consensus Document on Chronic Critical Leg Ischemia. Europ J Vasc Surg. 1992;6 suppl A:1-32.

5. Pokrovsky A.V., Dan V.N., Zotikov A.E. Complex treatment of patients with obliterating diseases of lower limb arteries without critical ischemia. Vrach. 2011;14:57-60. (In Russ.)

6. Dedov I.I. Diabetes mellitus in the Russian Federation: problems and solutions. Diabetes. 1998;16:7-21 (In Russ.)

7. Holdsworth R.J. District Hospital Managenent and Outcome of Critical Lower Limb Ischemia: Comparison with National Figures. Europ J Vasc Endovasc Surg. 1997;2:159-63.

8. Pell J., Stonebridge P. Association Between Age and Survival Following Major Amputation. Europ J Vasc Endovasc Surg. 1999;17(2):166-9.

9. Long-term mortality and its predictors in patients with critical leg ischaemia. The I.C.A.I. Group (Gruppo di Studio dell'Ischemia Cronica Critica degli Arti Inferiori). The Study Group of Criticial Chronic Ischemia of the Lower Exremities. Europ J Vasc Endovasc Surg. 1997;14(2):91-5.

10. Adam D.J., Beard J.D., Cleveland T. et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925-34. doi:10.1016/S0140-6736(05)67704-5.

11. Stoyioglou A., Jaff M.R. Medical treatment of peripheral arterial disease: a comprehensive review. J Vasc Interv Radiol. 2004;15:1197-207. doi:10.1097/01.RVI.0000137978.15352.C6.

12. Norgren L., Hiatt W.R., Dormandy J.A. et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45:5-67. doi:10.1016/j.jvs.2006.12.037.

13. National guidelines for management of patients with vascular pathology. Russian Conciliation Document (2012). Moscow: NTSSSH n.a. A.N. Bakulev RAMS; 2012. (In Russ.)


For citation:


Zagorulko A.I., Kolosov R.V., Sidelnikov A.V., Korzheva Y.V., Koledinsky A.G. Combined Endovascular Treatment of Acute Coronary Syndrome with Bioresorbable Scaffolds and Angioplasty in Patient with Critical Lower Limb Ischemia – Hybrid Treatment in Multidisciplinary Hospital. Rational Pharmacotherapy in Cardiology. 2018;14(6):901-907. https://doi.org/10.20996/1819-6446-2018-14-6-901-907

Views: 113


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)