Long-term outcomes of two treatment strategies for critical limb ischemia combined with coronary artery disease
Objective. To evaluate the long-term results of two treatment strategies for critical limb ischemia (CLI) combined with coronary artery disease (CAD). Material and methods. A single-center retrospective study included 102 patients with CLI and CAD who underwent endovascular and open surgical interventions in both vascular beds. Cardiovascular team made a decision regarding the method and stages of revascularization. Patients were divided into 2 groups depending on revascularization strategy for both arterial systems: group 1 - endovascular treatment (staged PCI and angioplasty of lower limb arteries) (n=53, 50.3%); group 2 - combined treatment (staged PCI combined with open bypass procedures for claudication) (n=49, 48.0%). Long-term treatment outcomes within 7 - 51 months (median 31.5 months) were studied in 85 (85%) out of 100 patients discharged from the Center considering the data of repeated hospitalizations (13.0%), outpatient examinations (34.2%), survey and telephone interviewing (52.8%). Results. Overall mortality was 14.1% (13.6% and 4.6%, respectively, p=0.89)). Overall cardiovascular mortality was 7.0% (6.8% and 7.3%, respectively p=0.92), overall non-cardiovascular mortality - 7.0% (6.8% and 7.3%, respectively, p=0.92). Overall incidence of stroke was 3.5% (4.5% and 2.4%, respectively, p=0.59). Recurrence of angina occurred in 2.3% of patients in the 1st group and no recurrence of angina was observed in the 2nd group. Overall incidence of recurrent lower limb ischemia was 7.0% (9.0% and 5.0%, respectively, p=0.44), overall incidence of amputations of lower extremities - 3.5% (4.5% and 2.4%, respectively, p=0.59). Non-fatal myocardial infarction was absent in both groups. Conclusion. Incidence of cardiovascular complications and adverse events in lower limb arteries was similar in long-term follow-up period after endovascular (group 1) and combined treatment (group 2) of patients with CLI and CAD (p>0.5). Overall long-term cardiovascular mortality was 7.0%, incidence of stroke - 3.5%. Non-fatal myocardial infarction was not detected in both groups. Both treatment strategies in patients with CLI and CAD showed high safety and clinical efficacy in early and long-term postoperative periods and can be widely used in everyday clinical practice.