ENDOVASCULAR REVASCULARIZATION METHODS IN THE TREATMENT OF ACUTE LOWER LIMB ISCHEMIA: THE CURRENT STATE OF KNOWLEDGE
Objective: To determine the role and significance of endovascular revascularization methods in treating acute lower limb ischemia (ALLI) from the perspective of modern literature. Methods: A literature search was conducted on publications in Russian and English at the medical literature platforms...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Avicenna Tajik State Medical University
2025-03-01
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| Series: | Паёми Сино |
| Subjects: | |
| Online Access: | https://doi.org/10.25005/2074-0581-2025-27-1-155-169 |
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| Summary: | Objective: To determine the role and significance of endovascular revascularization methods in treating acute lower limb ischemia (ALLI) from the perspective of modern literature.
Methods: A literature search was conducted on publications in Russian and English at the medical literature platforms on endovascular methods used in the treatment of ALLI. The search was performed in PubMed, Google Scholar, Web of Science, Cochrane.org, CyberLeninka.ru, and eLibrary.ru databases over the past 10 years (except for one historical study from 1994). The key search terms included: acute lower limb ischemia, endovascular thrombolysis, thrombaspiration, angioplasty, and stenting. Of the over 3,000 scientific papers, 59 articles were selected and subjected to scientific analysis.
Results: Literature data indicate an annual increase in the number of endovascular procedures performed for ALLI treatment. This growth is attributed not only to their minimally invasive nature but also to their capability for more precise visualization of emboli, thrombotic masses, organic vascular changes, and the angioarchitecture of the affected limbs. To achieve adequate limb revascularization in acute ischemia, endovascular technologies are recommended in an isolated or hybrid approach combined with open surgery. In co-morbid patients with ALLI, endovascular interventions are more justified, as they not only revascularize the limb but also enable simultaneous correction of other concomitant vascular lesions. Moreover, these techniques significantly reduce the incidence of intra- and postoperative complications, limb amputations, and early post-intervention mortality. However, currently there is no consensus on endovascular treatment for ALLI, leading to different specialists employing various treatment approaches to endovascular technologies. The disadvantages and complications of endovascular techniques include contrast-induced nephropathy, thrombus fragmentation with distal embolization, a high risk of bleeding with thrombolytic therapy, and hemolysis.
Conclusion: In recent years, endovascular revascularization technologies have been increasingly used in treating patients with ALLI, demonstrating excellent immediate results compared to traditional surgical interventions. However, the long-term outcomes of their use in isolated form or a hybrid mode with open surgeries require further study. Moreover, despite the advantages of these technologies, there has been no significant reduction in limb amputation rates in cases of late-diagnosed ALLI. There is a need for further improvement of existing endovascular treatment methods for ALLI, primarily focusing on reducing the incidence of early rethrombosis and limb amputation and developing alternative vascular contrast methods that do not involve iodine-based contrast agents. |
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| ISSN: | 2074-0581 2959-6327 |