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SURGICAL TREATMENT STRATEGIES IN PATIENTS WITH CRITICAL LIMB
ISCHEMIA COMBINED WITH ISCHEMIC HEART DISEASE
Iriskulov Akbarjon Odilovich
Republican Specialized Scientific and Practical Medical Center of Cardiology
https://doi.org/10.5281/zenodo.17311070
Introduction:
Critical limb ischemia (CLI) is a severe manifestation of peripheral arterial disease, often
associated with ischemic heart disease (IHD). Mortality and morbidity remain high due to the
systemic nature of atherosclerosis and perioperative cardiac complications. Optimizing treatment
strategies in this group remains a clinical challenge.
Materials and Methods:
Analysis of clinical data and published studies was performed to evaluate outcomes of
different revascularization approaches in CLI patients with coexisting IHD. Particular attention
was given to the role of hybrid operations, routine coronary evaluation, and perioperative
optimization.
Results:
The prevalence of IHD among CLI patients reaches 60–80%, and cardiovascular death is
the leading cause of mortality, accounting for nearly half of all deaths. Coronary angiography
before peripheral revascularization frequently reveals significant coronary stenoses, indicating the
need for combined management. Studies demonstrate that staged or hybrid strategies, integrating
open reconstruction of femoral arteries with endovascular iliac stenting, reduce operative trauma
and perioperative cardiac events. In our analysis, all patients achieved relief of CLI, confirmed by
pain regression and increased ankle-brachial index. In the bifurcation aorto-femoral bypass group,
one patient developed myocardial infarction with subsequent renal failure, resulting in death,
while several others experienced non-fatal coronary syndromes. In the hybrid group, acute
coronary syndromes occurred but were managed conservatively without fatalities. Preoperative
therapy including aspirin, statins, and beta-blockers for at least seven days contributed to
perioperative stability.
Conclusion:
CLI patients with concomitant IHD remain at high surgical risk. Hybrid procedures and
targeted preoperative preparation significantly reduce complications. Multidisciplinary approaches
are essential to improve survival and long-term outcomes.
Keywords:
critical limb ischemia; ischemic heart disease; aorto-femoral bypass; hybrid
surgery; revascularization; perioperative complications.
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