Results of Surgical Treatment of Patients with Critical Limb Ischemia and Stenotic Lesions of the Brachiocephalic Arteries

The aim of our study was to evaluate the results of the surgical treatment for patients with critical limb ischemia (CLI) and stenotic lesions of the brachiocephalic arteries. Methods and Results: We examined 72 patients (68/87.2% men and 4/7.3% women) aged from 46 to 78 years (mean age, 62.2±4.3 years) with CLI and stenotic lesions of the brachiocephalic arteries. Conservative treatment was performed in 17(23.6%) patients and surgical treatment in 55(76.4%). It has been carried out 73 surgical operations: femoral popliteal bypass (5/6.8%), lumbar sympathectomy (4/5.5%), thrombectomy of occluded aortofemoral graft (2/2.7%), limb amputation (4/5.5%), iliofemoral bypass (4/5.5%), aortofemoral bifurcation bypass (10/13.1%), endovascular surgery (1/1.6%), limb amputation at thigh level - 4(5.5%), thrombectomy of occluded distal arteries (4/5.5%), femoro-femoral cross-over bypass (1/1.6%), resection of popliteal artery aneurysm and prosthesis of the popliteal artery (1/1.6%), semi-closed loop endarterectomy of occluded arteries of the lower limbs (8/10.9%), carotid endarterectomy (23/31.5%), and carotid-subclavian bypass (2/2.7%). After the surgical intervention, we observed the disappearance or reduction of pain, restoration of sensitivity and motor activity, and healing of trophic ulcers in 75% of patients. In the late postoperative period, we detected the progression of limb ischemia in 4(5.5%) patients; in connection with that, we performed limb amputation at thigh level. Ischemic stroke with a lethal outcome developed in one patient (1.4%). Conclusion: In patients with multifocal atherosclerosis, multilevel reconstructive surgical interventions must be performed in stages, due to the high operational risk, and risk of complications, secondary amputations and lethality in the postoperative period