S.V. Mshar, V.А. Yanushko
Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3–5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).
keywords: peripheral artery disease, elderly patient, comorbidity, critical limb ischemia, endovascular surgery, hybrid surgery, angioplasty, stenting

for references: S.V. Mshar, V.А. Yanushko. The role of X-ray endovascular surgery in the treatment of obliterating atherosclerosis of the lower extremity arteries in elderly and senile patients. Neotlozhnaya kardiologiya i kardioovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2020, vol. 4, no. 2, pp. 1069–1073

1. Savji N., Rockman C.B., Skolnik A.H., Guo Y., Adelman M.A., Riles T., Berger J.S. Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects. JACC, 2013, vol. 61, no. 16, pp. 1736-1743. doi: 10.1016/j.jacc.2013.01.054.
2. Medvedeva I.V., Kangro I.S., Vasilevskaya Zh.N. i dr. Demograficheskij ezhegodnik Respubliki Belarus [Demographic yearbook of the Republic of Belarus]. Statisticheskij sbornik. Naczionalnyj statisticheskij komitet Respubliki Belarus, Minsk, 2019. 429 s. (in Russian).
3. Fowkes F.G., Aboyans V., Fowkes F.J., McDermott M.M., Sampson U.K.A., Criqui M.H. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol, 2016, vol. 14, pp. 156-170. doi: 10.1038/nrcardio.2016.179.
4. Sigvant B., Lundlin F., Wahlberg E. The risk of disease progression in peripheral artery disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral artery disease. Eur J Vasc Endovasc Surg, 2016, vol. 51, no. 3, pp. 395-403. doi: 10.1016/j.ejvs.2015.10.022.
5. Aronow W.S. Peripheral arterial disease in the elderly. Clinical Intervention in Aging, 2007, vol. 2, no. 4, pp. 645-654. doi: 10.2147/cia.s2412
6. Bell S.P., Saraf A.A. Epidemiology of multimorbidity in older adults with cardiovascular disease. Clin Geriatr Med, 2016, vol. 32, no. 2, pp. 215-226 doi: 10.1016/j.cger.2016.01.013.
7. Miller A.P., Hulff C.M., Roubin G.S. Vascular disease in the alder adult. J Geriatr Cardiol, 2016, vol. 13. doi: 10.11909/j.issn.1671-5411.2016.09.011.
8. Meijer W.T., Grobbee D.E., Hunink M.G., Hofman A., Hoes A.W. Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med, 2000, vol. 160, pp. 2934-2938.
9. Higashitani M., Uemura Y., Mizuno A., Utsunomiya M., Yamaguchi T., Matsui A., Ozaki S., Tobita K., Tosaka A., Oida A. et al. Cardiovascular outcome and mortality in patients undergoing endovascular treatment for symptomatic peripheral artery disease – short-term results of the Toma-Code registry. Circ J, 2018, vol. 82. doi: 10.1253/circj.CJ-18-0105.
10. Mustapha J.A., Diaz-Sandoval L.J., Adams G., Jaff M.R., Beasley R., McGoff T., Finton S., Miller L.E., Ansari M., Saab F. Lack of association between limb hemodynamics and response to infrapopliteal endovascular therapy in patients with critical limb ischemia. J Invasive Cardiol, 2017, vol. 29, no. 5, pp. 175-180.
11. Eid A., Nikol S. Endovascular management of patients with peripheral vascular disease with cardiovascular multi-morbidity. Cor et Vasa, 2018, vol. 60, no. 1, pp. 35-41. doi: 10.1016/j.crvasa.2017.10.001.
12. Bradbury A.W., Adam D.J., Bell J., Forbes J.F., Fowkes F.G.R., Gillespie I., Ruckley C.V., Raab G.M. Bypass versus angioplasty in severe ischemia of leg (BASIL) trial: analysis of amputation free and overall survival by treatment received. J Vasc Surg, 2010, vol. 51, pp. 18s-31s. doi: 10.1016/j.jvs.2010.01.074.
13. Causey M.W., Ahmed A., Wu B., Gasper W.J., Reyzelman A., Vartanian S.M., Hiramoto J.S., Conte M.S. Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program. J Vasc Surg, 2016, vol. 63, no. 6, pp. 1563-1573. doi: 10.1016/j.jvs.2016.01.011.
14. Klaphake S., de Leur K., Mulder P.G., Ho G.H., de Groot H.G., Veen E.J., Verhagen H.J., van der Laan L. Mortality after major amputation in elderly patients with critical limb ischemia. Clin Interv Aging, 2017, vol. 12, pp. 1985-1992. doi: 10.2147/CIA.S137570.
15. Moise, M.A., Alvarez-Tostado J.A., Clair D.G., Greenberg R.K., Lyden S.P., Srivastava S.D., Eagleton M., Sarac T.S., Kashyap V.S. Endovascular management of chronic infrarenal aortic occlusion. J Endovasc Ther, 2009, vol. 16, no 1, pp. 84-92. doi: 10.1583/08-2526.1.
16. Alukhanyan O.A., Martirosyan Kh.G., Mokhamed Kallob A.M. Osobennosti khirurgicheskoj taktiki pri kriticheskoj ishemii nizhnikh konechnostej u bol`ny`kh pozhilogo i starcheskogo vozrasta [Surgical management of elderly and senile patients with critical lower extremity ischemia]. Angiologiya i sosudistaya khirurgiya, 2003, tom 3, no. 4, pp. 106-109. (in Russian).
17. Ahmed M.T. Ghanem, Eltabbakh A.R. Role of pathology in the decision making of SFA chronic total occlusion: a narrative review article. J Surg Res, 2019, vol. 2, no. 2, pp. 34-46. doi: 10.26502/jsr.10020017.
18. Katsanos K., Tepe G., Tsetis D., Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and. Cardiovasc Intervent Radiol, 2014, vol. 37, no. 3, pp. 592-603.
19. Bishu K., Armstrong E.J., Supera self-expanding stents for endovascular treatment of femoropopliteal disease: a review of the clinical evidence. Vasc Health Risk Manag, 2015, vol. 11, pp. 387-395. doi: 10.2147/VHRM.S70229.
20. Soderstrom M.I., Arvela E.M., Korhonen M., Halmesmäki K.H., Albäck A.N., Biancari F., Lepäntalo M.J., Venermo M.A. Infrapopliteal percutaneous transluminal angioplasty versus bypass surgery as first line strategies in critical leg ischemia: a propensity score analysis. Ann Surg, 2010, vol. 252, no. 5, pp. 765-673. doi: 10.1097/SLA.0b013e3181fc3c73.
21. Jens S., Conijn A.P., Koelemay M.J., Bipat S., Reekers J.A. Randomized trials for endovascular treatment of infrainguinal arterial disease: systematic review and meta-analysis (part 2: below the knee). Eur J Vasc Endovasc Surg, 2014, vol. 47, no 5, pp. 536-544.
22. Narula N., Dannenberg A.J., Olin J.W., Bhatt D.L., Johnson K.W., Nadkarni G., Min J., Torii S., Poojary P., Anand S.S., Bax J.J., Yusuf S., Virmani R., Narula J. Pathology of peripheral artery disease in patients with critical limb ischemia. J Am Coll Cardiol, 2018, vol. 72, no. 18, pp. 2152-2163. doi: 10.1016/j.jacc.2018.08.002.
23. Zeller T., Baumgartner I., Scheinert D., Brodmann M., Bosiers M., Micari A., Peeters P., Vermassen F., Landini M., Snead D.B. et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the IN.PACT DEEP randomized trial. J Am Coll Cardiol, 2014, vol. 64, no. 15, pp. 1568-1576. doi: 10.1016/j.jacc.2014.06.1198.
24. Rastan, A., Bechtel K., Krankenberg H., Zahorsky R., Tepe G., Noory E., Schwarzwälder U., Macharzina R., Schwarz T., Bürgelin K., Sixt S., Tübler T., Neumann F.-J., Zeller T. Sirolimus-eluting stents for treatment of infrapopliteal arteries reduce clinical event rate compared to bare-metal stents. J Am Coll Cardiol, 2012, vol. 60, no 7, pp. 587-591. doi: 10.1016/j.jacc.2012.04.035.
25. Lee M.S., Beasley R., Adams G.L. Impact of advanced age on procedural and acute angiographic outcomes in patients treated for peripheral artery disease with orbital atherectomy: a CONFIRM registries subanalysis. J Invasive Cardiol, 2015, vol. 27, no. 8, pp. 381-386.
26. Gentile F., Lundberg G., Hultgren R. Outcomes for endovascular and open procedures in infrapopliteal lesions for critical limb ischemia: registry based single center study. Eur J Vasc Endovasc Surg, 2016, vol. 52, no. 5, pp. 643-649. doi: 10.1016/j.ejvs.2016.07.013.
27. Patel S.D., Biasi L., Paraskevopoulos I., Silickas J., Lea T., Diamantopoulos A., Katsanos K., Zayed H. Comparison of angioplasty and bypass surgery for critical limbischemia in patients with infrapopliteal peripheral artery disease. Br J Surg, 2016, vol. 103, no. 13, pp. 1815-1822. doi: 10.1002/bjs.10292.
28. Movchan K.N., Sukhov V.K., Artyushin B.S. i dr. Vozmozhnosti ispol`zovaniya v regionarny`kh sosudisty`kh czentrakh e`ndovaskulyarny`kh metodik lecheniya paczientov, stradayushhikh kriticheskoj ishemiej nizhnikh konechnostej [Possibilities of using endovascular methods of treatment of patients with critical limb ischemia in regional vascular centers]. Vestnik Rossijskoj voenno-mediczinskoj akademii, 2018, vol. 4, no. 64, ss. 164-168. (in Russian).
29. Joh J.H., Joo S.H., Park H.C. Simultaneous hybrid revascularization for symptomatic lower extremity arterial occlusive. Exp Ther Med, 2014, vol. 7, no. 4, pp. 804-810.
30. Lee S.C., Joh J.H., Chang J.H. Kim H.-K., Kim J.Y., KiHyuk Park, Hong Ki C., Byun S.J., Lee T.S., Jung H.J., Lee S.S. Hybrid treatment of multilevel revascularization in patients with peripheral artery disease – a multi-centre study in Korea. Vasa, 2018, vol. 47, no. 3, pp. 235-241. doi: 10.1024/0301-1526/a000694.
File extension: pdf (334.14 KB)