Aspects of treatment of peripheral artery disease in patients with multifocal atherosclerosis and aortic aneurysm
https://doi.org/10.18705/3034-7270-2025-1-3-20-28
EDN: KWLISH
Abstract
This article provides an overview of current surgical options for treating peripheral arterial disease of the lower extremities, including those in comorbid patients with multifocal atherosclerosis and abdominal aortic aneurysms. The article presents data from large randomized trials comparing early and late outcomes of lower extremity vascular revascularization. The article analyzes outcomes of various approaches to abdominal aortic aneurysms reconstruction, including small abdominal aortic aneurysms in high-risk patients. The literature data are illustrated by a clinical example from our own practice. A case of successful open surgical reconstruction is described: aortobifemoral bypass grafting in a patient with generalized atherosclerosis and infrarenal aortic aneurysm with a 6-month follow-up period.
Keywords
About the Authors
R. E. TadevosyanРоссия
Tadevosyan Ruben E. – Physician, Vascular Surgeon.
St. Petersburg
A. Yu. Apresyan
Россия
Apresyan Artur Yu. – Candidate of Medical Sciences, Associate Professor.
St. Petersburg
References
1. Batluk T.I., Tarlovskaya E.I., Arutyunov G.P. and others. The clinical registry for the study of the population of patients with revealed multifocal atherosclerosis in the territory of the Russian Federation and the countries of Eurasia is KAMMA. Complex problems of cardiovascular diseases. 2023;12(2):6–13. DOI: 10.17802/2306-1278-2023-12-2-6-13. (In Russ.).
2. Bhatt D.L., Steg P.G., Ohman E.M., et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295:180–9. DOI: 10.1001/jama.295.2.180.
3. Suárez C., Zeymer U., Limbourg T., et al. Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH registry. Vasc Med. 2010;15:259–65. DOI: 10.1177/1358863x10373299.
4. Aboyans V., Ricco J.B., Bartelink M.E.L. et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39:763–816. DOI: 10.1093/eurheartj/ehx095.
5. Nordanstig J.A., George A.B., Jonathan R., et al. European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. European Journal of Vascular and Endovascular Surgery. 2024;67(1):9–96. DOI: 10.1016/j.ejvs.2023.08.067.
6. Koelemay M.J.W., van Reijen N., van Dieren S., et al. Editor’s Choice – Randomised Clinical Trial of Supervised Exercise Therapy vs. Endovascular Revascularisation for Intermittent Claudication Caused by Iliac Artery Obstruction: The SUPER study. Eur J Vasc Endovasc Surg. 2022;63(3):421–429. DOI: 10.1016/j.ejvs.2021.09.042.
7. Klaphake S., Fakhry F., Rouwet E.V., et al. Long-term Follow-up of a Randomized Clinical Trial Comparing Endovascular Revascularization Plus Supervised Exercise with Supervised Exercise Only for Intermittent Claudication. Ann Surg. 2022;276(6):E1035–E1043. DOI: 10.1097/SLA.0000000000004712.
8. Lindgren H.I.V., Qvarfordt P., Bergman S., Gottsäter A. Primary Stenting of the Superficial Femoral Artery in Patients with Intermittent Claudication Has Durable Effects on Health-Related Quality of Life at 24 Months: Results of a Randomized Controlled Trial. Cardiovasc Intervent Radiol. 2018;41(6):872–881. DOI: 10.1007/s00270-018-1925-0.
9. Li B., Rizkallah P., Eisenberg N., et al. Rates of Intervention for Claudication versus Chronic Limb-Threatening Ischemia in Canada and United States. Ann Vasc Surg. 2022;82:131–143. DOI: 10.1016/j.avsg.2021.10.068.
10. Bath J., Lawrence P.F., Neal D., et al. Endovascular interventions for claudication do not meet minimum standards for the Society for Vascular Surgery efficacy guidelines. Journal of Vascular Surgery. 2021;73(5):1693–1700.e3. DOI: 10.1016/j.jvs.2020.10.067.
11. Pandey A., Banerjee S., Ngo C. et al. Comparative Efficacy of Endovascular Revascularization Versus Supervised Exercise Training in Patients with Intermittent Claudication: MetaAnalysis of Randomized Controlled Trials. JACC Cardiovasc Interv. 2017;10(7):712–724. DOI: 10.1016/j.jcin.2017.01.027.
12. Crawford E.S., Bomberger R.A., Glaeser D.H., et al. Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a twentyfive-year period. Surgery. 1981;90(6):1055–1067.
13. Vértes M., Juhász I.Z., Nguyen T.D. et al. Stent Protrusion >20 mm Into the Aorta: A New Predictor for Restenosis After Kissing Stent Reconstruction of the Aortoiliac Bifurcation. Journal of Endovascular Therapy. 2018;25(5):632–639. DOI: 10.1177/1526602818794959.
14. Indes J.E., Pfaff M.J., Farrokhyar F. et al. Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther. 2013;20:443–455. DOI: 10.1583/13-4242.1.
15. DeCarlo C., Latz C.A., Boitano L.T. et al. An EndovascularFirst Approach for Aortoiliac Occlusive Disease is Safe: Prior Endovascular Intervention is Not Associated with Inferior Outcomes after Aortofemoral Bypass. Annals of Vascular Surgery. 2021;70:62–69. DOI: 10.1016/j.avsg.2020.07.023.
16. Isselbacher E.M., Preventza O., Hamilton B.J.3rd, et al. Peer Review Committee Members. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association. American College of Cardiology Joint Committee on Clinical Practice Guidelines. 2022;146(24):e334–e482. DOI: 10.1161/CIR.0000000000001106.
17. De Bruin J.L., Baas A.F., Buth J., et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881–1889. DOI: 10.1056/NEJMoa0909499.
18. Becquemin J.P., Pillet J.C., Lescalie F., et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in lowto moderaterisk patients. J Vasc Surg. 2011;53:1167–1173.e1161. DOI: 10.1016/j.jvs.2010.10.124.
19. Lederle F.A., Freischlag J.A., Kyriakides T.C., et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302:1535–1542. DOI: 10.1001/jama.2009.1426.
20. Lederle F.A., Freischlag J.A., Kyriakides T.C., et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012;367:1988–1997. DOI: 10.1056/NEJMoa1207481.
21. Lederle F.A., Kyriakides T.C., Stroupe K.T., et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2019;380:2126–2135. DOI: 10.1056/NEJMoa1715955.
22. Patel R., Sweeting M.J., Powell J.T., et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388: 2366–2374. DOI: 10.1016/S0140-6736(16)31135-7.
23. Herman C.R., Charbonneau P., Hongku K., et al. Any nonadherence to instructions for use predicts graftrelated adverse events in patients undergoing elective endovascular aneurysm repair. J Vasc Surg. 2018;67:126–133. DOI: 10.1016/j.jvs.2017.05.095.
24. Schermerhorn M.L., O’Malley A.J., Jhaveri A., et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358:464–474. DOI: 10.1056/NEJMoa0707348.
25. Beckerman W.E., Tadros R.O., Faries P.L., et al. No major difference in outcomes for endovascular aneurysm repair stent grafts placed outside of instructions for use. J Vasc Surg. 2016;64:63–74.e62. DOI: 10.1016/j.jvs.2016.01.034.
26. O’Donnell T.F.X., Boitano L.T., Deery S.E., et al. Open versus fenestrated endovascular repair of complex abdominal aortic aneurysms. Ann Surg. 2020;271:969–977. DOI: 10.1097/SLA.0000000000003094.
27. Jones A.D., Waduud M.A., Walker P., et al. Metaanalysis of fenestrated endovascular aneurysm repair versus open surgical repair of juxtarenal abdominal aortic aneurysms over the last 10 years. BJS Open. 2019;3:572–584. DOI: 10.1002/bjs5.50178.
28. Walsh K., O’Connor D.J., Weaver F., et al. Survival after endovascular therapy in patients with ruptured thoracic aortic diseases: results from the Global Registry for Endovascular Aortic Treatment Registry. J Vasc Surg. 2020;72:1544–1551. DOI: 10.1016/j.jvs.2020.02.022.
29. Varkevisser R.R.B., Swerdlow N.J., de Guerre L., et al. Fiveyear survival following endovascular repair of ruptured abdominal aortic aneurysms is improving. J Vasc Surg. 2020;72:105–113.e4. DOI: 10.1016/j.jvs.2019.10.074.
30. Antoniou G.A., Antoniou S.A., Torella F. Editor’s choice – endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term data of randomised controlled trials. Eur J Vasc Endovasc Surg. 2020;59:385–397. DOI: 10.1016/j.ejvs.2019.11.030.
31. Brown L.C., Epstein D., Manca A., et al. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. Eur J Vasc Endovasc Surg. 2004;27:372–381. DOI: 10.1016/j.ejvs.2003.12.019.
32. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomized controlled trial. Lancet. 2005;365:2187–2192. DOI: 10.1016/S0140-6736(05)66628-7.
33. Sweeting M.J., Patel R., Powell J.T., et al. Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: very long-term follow-up in the EVAR-2 randomized controlled trial. Ann Surg. 2017;266:713–719. DOI: 10.1097/SLA.0000000000002392.
34. Adkar S.S., Turner M.C., Leraas H.J., et al. Low mortality rates after endovascular aortic repair expand use to highrisk patients. J Vasc Surg. 2018;67:424–432.e421. DOI: 10.1016/j.jvs.2017.06.107.
35. Schermerhorn M.L., O’Malley A.J., Jhaveri A., et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358:464–474. DOI: 10.1056/NEJMoa0707348.
36. Bertges D.J., Neal D., Schanzer A., et al. The Vascular Quality Initiative Cardiac Risk Index for prediction of myocardial infarction after vascular surgery. J Vasc Surg. 2016;64:1411–1421.e4. DOI: 10.1016/j.jvs.2016.04.045.
37. Eslami M.H., Rybin D., Doros G., et al. Comparison of a Vascular Study Group of New England risk prediction model with established risk prediction models of in-hospital mortality after elective abdominal aortic aneurysm repair. J Vasc Surg. 2015;62:1125–1133.e1122. DOI: 10.1016/j.jvs.2015.06.051.
38. Eslami M.H., Rybin D.V., Doros G., et al. External validation of Vascular Study Group of New England risk predictive model of mortality after elective abdominal aorta aneurysm repair in the Vascular Quality Initiative and comparison against established models. J Vasc Surg. 2018;67:143–150. DOI: 10.1016/j.jvs.2017.05.087.
39. Varkevisser R.R.B., O’Donnell T.F.X., Swerdlow N.J., et al. Fenestrated endovascular aneurysm repair is associated with lower perioperative morbidity and mortality compared with open repair for complex abdominal aortic aneurysms. J Vasc Surg. 2019;69:1670–1678. DOI: 10.1016/j.jvs.2018.08.192.
Review
For citations:
Tadevosyan R.E., Apresyan A.Yu. Aspects of treatment of peripheral artery disease in patients with multifocal atherosclerosis and aortic aneurysm. Russian surgical journal. 2025;1(3):20-28. (In Russ.) https://doi.org/10.18705/3034-7270-2025-1-3-20-28. EDN: KWLISH
JATS XML
