Authors

  • Akbarjon Iriskulov

DOI:

https://doi.org/10.71337/inlibrary.uz.science-research.137185

Keywords:

critical lower limb ischemia coronary artery disease bifurcation aorto-femoral bypass hybrid surgery.

Abstract

The majority of patients with critical lower limb ischemia (CLLI) also suffer from coronary artery disease (CAD). After reconstructive operations in the aorto-iliac region, the risks of myocardial infarction and mortality remain high. Therefore, the sequence of coronary and limb revascularization remains a pressing issue.

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Oktabr, 2025-Yil

58

SURGICAL TREATMENT OF PATIENTS WITH CRITICAL LOWER LIMB

ISCHEMIA AND CORONARY ARTERY DISEASE

Iriskulov Akbarjon Odilovich

Republican Specialized Scientific and Practical Medical Center of Cardiology

https://doi.org/10.5281/zenodo.17311089

Abstract.

The majority of patients with critical lower limb ischemia (CLLI) also suffer from

coronary artery disease (CAD). After reconstructive operations in the aorto-iliac region, the risks
of myocardial infarction and mortality remain high. Therefore, the sequence of coronary and limb
revascularization remains a pressing issue.

Keywords:

critical lower limb ischemia; coronary artery disease; bifurcation aorto-

femoral bypass; hybrid surgery.

Materials and Methods.

This study presents the outcomes of treatment in 131 patients

with CLLI and CAD involving the aorto-iliac segment. All patients underwent lower limb
revascularization as the first stage. Bifurcation aorto-femoral bypass (BAFB) was performed in 88
patients (67.2%), while 43 patients (32.8%) underwent hybrid reconstruction of the aorto-iliac
segment, including open femoral artery reconstruction and endovascular iliac stenting. Critical
ischemia was resolved in all patients. No deaths were recorded among patients who underwent
hybrid procedures, whereas 1 patient (1.1%) died after BAFB.

Results.

After surgery, CLLI was eliminated in all patients (100%), as confirmed by

disappearance of resting pain and an ankle–brachial index (ABI) increase above 0.4. In group 1, 1
patient (0.76%) developed acute myocardial infarction followed by death, and 5 patients (3.8%)
developed acute coronary syndrome with ST-segment depression but without hemodynamic
instability. In group 2, 4 patients (3.05%) developed acute coronary syndrome with ST-segment
depression, but no deaths occurred.

Conclusion.

In patients with concomitant CLLI and CAD, the traditional staged approach

is associated with high risks. Our findings indicate that hybrid surgery reduces surgical trauma,
while at least 7 days of preoperative preparation improves cardiac stability. Optimal management
should include preoperative preparation, hybrid surgical approaches, and an individualized
assessment of risks.

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Oktabr, 2025-Yil

59

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Oktabr, 2025-Yil

60

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References

Adam, D. J., Beard, J. D., Cleveland, T., Bell, J., Bradbury, A. W., Forbes, J. F., ... & BASIL Trial Participants. (2005). Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. The Lancet, 366(9501), 1925–1934. https://doi.org/10.1016/S0140-6736(05)67704-5

Schillinger, M., Sabeti, S., Loewe, C., Dick, P., Amighi, J., Mlekusch, W., ... & Minar, E. (2006). Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. New England Journal of Medicine, 354(18), 1879–1888. https://doi.org/10.1056/NEJMoa051303

Dake, M. D., Ansel, G. M., Jaff, M. R., Ohki, T., Saxon, R. R., Smouse, H. B., ... & Zeller, T. (2011). Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: Twelve-month Zilver PTX randomized study results. Circulation: Cardiovascular Interventions, 4(5), 495–504. https://doi.org/10.1161/CIRCINTERVENTIONS.111.962324

Zeller, T., Rastan, A., Macharzina, R., & Sixt, S. (2010). Current state of endovascular treatment of femoropopliteal artery disease. Vascular Medicine, 15(5), 419–428. https://doi.org/10.1177/1358863X10380741

Norgren, L., Hiatt, W. R., Dormandy, J. A., Nehler, M. R., Harris, K. A., & Fowkes, F. G. R. (2007). Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Journal of Vascular Surgery, 45(1), S5–S67. https://doi.org/10.1016/j.jvs.2006.12.037

Dormandy, J., Heeck, L., & Vig, S. (1999). The fate of patients with critical leg ischemia. Seminars in Vascular Surgery, 12(2), 142–147. https://doi.org/10.1016/S0895-7967(99)80039-2

Belch, J. J., Dormandy, J., CASPAR Writing Committee, ... & Biasi, G. M. (2008). Results of the randomized, placebo-controlled Clopidogrel and Acetylsalicylic Acid in Bypass Surgery for Peripheral Arterial Disease (CASPAR) trial. Journal of Vascular Surgery, 48(3), 613–623. https://doi.org/10.1016/j.jvs.2008.04.027

Nikol, S., Baumgartner, I., Van Belle, E., Diehm, C., Visonà, A., Capogrossi, M. C., ... & Vermorken, J. B. (2008). Therapeutic angiogenesis with intramuscular NV1FGF improves amputation-free survival in patients with critical limb ischemia. Molecular Therapy, 16(5), 972–978. https://doi.org/10.1038/mt.2008.59

Dormandy, J. A., Rutherford, R. B., & TASC Working Group. (2000). Management of peripheral arterial disease (PAD): TransAtlantic Inter-Society Consensus (TASC). Journal of Vascular Surgery, 31(1), S1–S296. https://doi.org/10.1016/S0741-5214(00)90150-5

Hiatt, W. R., Rogers, R. K., & Brass, E. P. (2008). The treadmill is a better functional test than the 6-minute walk test in therapeutic trials of patients with peripheral artery disease. Circulation, 117(22), 2811–2818. https://doi.org/10.1161/CIRCULATIONAHA.107.736127

Poldermans, D., Bax, J. J., Boersma, E., De Hert, S., Eeckhout, E., Fowkes, F. G. R., ... & Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management. (2009). Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. European Heart Journal, 30(22), 2769–2812. https://doi.org/10.1093/eurheartj/ehp337

Zeller, T., Baumgartner, I., Scheinert, D., Brodmann, M., Bosiers, M., Micari, A., ... & Dake, M. D. (2014). Drug-eluting balloons in the treatment of femoropopliteal artery disease: 24-month results from the IN.PACT SFA randomized trial. Circulation, 129(9), 987–995. https://doi.org/10.1161/CIRCULATIONAHA.113.006889

Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., ... & Murad, M. H. (2019). Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of Vascular Surgery, 69(6S), 3S–125S.e40. https://doi.org/10.1016/j.jvs.2019.02.016

Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., ... & Rooke, T. W. (2006). ACC/AHA guidelines for the management of patients with peripheral arterial disease. Journal of the American College of Cardiology, 47(6), 1239–1312. https://doi.org/10.1016/j.jacc.2005.10.009

Norgren, L., Hiatt, W. R., Dormandy, J. A., & Nehler, M. R. (2010). Critical limb ischemia: Epidemiology, natural history, and outcome. Journal of Cardiovascular Surgery, 51(2), 153–161.