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Treatment strategy for patients with chronic ischemia of the lower limbs in combination with ischemic heart disease

Authors: Alekyan B.G., Karapetyan N.G., Sedgaryan M.A.

Company: National medical research center of surgery A.V. Vishnevsky, Moscow, 117997, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2020-14-4-377-389

For citation: Alekyan B.G., Karapetyan N.G., Sedgaryan M.A. Treatment strategy for patients with chronic ischemia of the lower limbs in combination with ischemic heart disease. Creative Cardiology. 2020; 14 (4): 377–89 (in Russ.). DOI: 10.24022/1997-3187-2020-14-4-377-389

Received / Accepted:  05.09.2020 / 10.09.2020

Keywords: percutaneous coronary intervention stenting and balloon angioplasty of the arteries of the lower extremities combined lesion of the coronary arteries and arteries of the lower extremities multidisciplinary team chronic ischemia of the lower extremities critical ischemia of the lower extremities

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Abstract

Chronic ischemia of the lower extremities and coronary heart disease today remain one of the main socio-economic problems that mutually aggravate each other. The problem of treating patients with intermittent claudication with concomitant ischemic heart disease, despite the rapid development of medical technologies, remains one of the most important in medicine. The progression of the disease leads to the development of complications such as major cardiovascular events, the development of critical ischemia of the lower extremities and amputations, which are disabling diseases. This review article presents current trends in the management of patients with chronic lower limb ischemia in combination with coronary artery disease. For many years in Russian and world literature there is no single point of view on the management of patients with lesions of the arteries of the lower extremities in combination with coronary heart disease. The article shows different points of view (medical therapy, endovascular and surgical intervention) regarding the management and treatment of patients with chronic lower limb ischemia of stage 2B according to the Fontaine–Pokrovsky classification, the role of a multidisciplinary Vascular Team, the results of large studies, as well as current data on the treatment of intermittent claudication

References

  1. Conte M.S., Bradbury A.W., Kolh P., White J.V. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J. Vasc. Surg. 2019; 69 (6): 3–125. DOI: 10.1016/j.jvs.2019.02.016
  2. Bockeria L.A., Pokrovskiy A.V., Akchurin R.S., Alekyan B.G., Sapelkin S.V., Kuznetsov M.R. et al. National guidelines for the diagnosis and treatment of lower limb arterial diseases. 2018. Available at: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (accessed 20 August, 2020) (in Russ.).
  3. Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G.R. Inter-society consensus for the management of peripheral arterial disease (TASC II). J. Vasc. Surg. 2007; 45 (1): 5–67. DOI: 10.1016/j.jvs.2006.12.037
  4. Fowkes F.G., Rudan D., Rudan I., Aboyans V. Denenberg J., McDermott M. et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382 (9901): 1329–40. DOI: 10.1016/s0140-6736(13)61249-0
  5. Kullo I.J., Rooke T.W. Peripheral artery disease. New Eng. J. Med. 2016; 374 (9): 861–71. DOI: 10.1056/nejmcp1507631
  6. Bhatt D.L., Ohman E.M., Hirsch A.T., Ikeda Y., Mas J.L. et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2015; 295: 180–9. DOI: 10.1001/jama.295.2.180
  7. Savji N., Rockman C.B., Skolnick A.H., Guo Y., Adelman M.A., Riles T. et al. Association between advanced age and vascular disease in different arte385 Креативная кардиология. 2020; 14 (4) DOI: 10.24022/1997-3187-2020-14-4-377-389 Обзоры литературы rial territories. J. Am. Coll. Cardiol. 2013; 61 (16): 1736–43. DOI: 10.1016/j.jacc.2013.01.054
  8. Steg P.G., Bhatt D.L., Wilson P.W.F., Mittelmark M., Polak J.F. et al. REACH registry investigators, for the one-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007; 297 (11): 1197. DOI: 10.1001/jama.297.11.1197
  9. Newman A.B., Shemanski L., Manolio T.A., Cushman M. et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. Arterioscler. Thromb. Vasc. Biol. 1999; 19 (3): 538–45. DOI: 10.1161/01.atv.19.3.538
  10. Resnick H.E., Lindsay R.S., McDermott M.M., Devereux R.B., Jones K.L., Fabsitz R.R., Howard B.V. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the strong heart study. Circulation. 2004; 109 (6): 733–9. DOI: 10.1161/01.cir.0000112642.63927.54
  11. Begg T.B., Richards R.L. The prognosis of intermittent claudication. Scot. Med. J. 1962; 7 (8): 341–52. DOI: 10.1177/003693306200700802
  12. Juergens J.L., Barker N.W., Hines E.A. Arteriosclerosis obliterans: review of 520 cases with special reference to pathogenic and prognostic factors. Circulation. 1960; 21 (2): 188–95. DOI: 10.1161/01.cir.21.2.188
  13. Hirsch A.T., Haskal Z.J., Hertzer N.R., Bakal C.W., Creager M.A., Hiratzka L.F. et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation. 2006; 113: 463–4. DOI: 10.1161/Circulationaha.106.174526
  14. Rantner B., Kollerits B., Pohlhammer J., Stadler M., Lamina C., Peric S. et al. The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC study. Sci. Rep. 2017; 7 (1). DOI: 10.1038/srep45833
  15. Conte M.S., Bradbury A.W., Kolh P., White J.V., Committee S., Dick F. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur. J. Vasc. Endovasc. Surg. 2019; 58: 1–109. DOI: 10.1016/j.ejvs.2019.05.006
  16. Ziegler-Graham K., MacKenzie E.J., Ephraim P.L., Travison T.G., Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch. Phys. Med. Rehab. 2008; 89 (3): 422–9. DOI: 10.1016/j.apmr.2007.11.005
  17. Aboyans V., Ricco J.B., Bartelink M.L., Björck M., Brodmann M., Cohnert T. 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. 2017; 39 (9): 763–816. DOI: 10.1093/eurheartj/ehx095
  18. Conte M.S., Pomposelli F.B., Clair D.G., Geraghty P.J., McKinsey J.F., Mills J. et al. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J. Vasc. Surg. 2015; 61 (3): 2–41. DOI: 10.1016/j.jvs.2014.12.009
  19. Howell M.A., Colgan M.P., Seeger R.W., Ramsey D.E., Sumner D.S. Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: a six-year follow-up study. J. Vasc. Surg. 1989; 9 (5): 691–7. DOI: 10.1016/s0741-5214(89)70041-0
  20. Criqui M.H., Langer R.D., Fronek A., Reigelson H.S., Klauber M.R., McCann T.J. et al. Mortality over a period of 10 years in patients with peripheral arterial disease. New Eng. J. Med. 1992; 326 (6): 381–6. DOI: 10.1056/nejm199202063260605
  21. Bockeria L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Diseases and congenital anomalies of the circulatory system. Cardiovascular Surgery – 2017. Moscow; 2018 (in Russ.)
  22. Alekyan B.G., Pokrovsky A.V., Karapetyan N.G., Revishvili А.S. A multidisciplinary approach in determining of prevalence of coronary artery disease and treatment strategies in patients with pathology of the aorta and peripheral arteries. Russian Journal of Cardiology. 2019; (8): 8–16 (in Russ.). DOI: 10.15829/1560-4071-2019-8-8-16
  23. Zheng Z., Sharrett A.R., Chambless L.E. et al. Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the atherosclerosis risk in communities (ARIC) study. Atherosclerosis. 1997; 131 (1): 115–25. DOI: 10.1016/s0021-9150(97)06089-9
  24. Olinic D., Spinu M., Olinic M., Homorodean C., Tataru D.A., Liew A. et al. Epidemiology of peripheral artery disease in Europe: VAS educational paper. Int. Angiol. 2018; 37: 327–34. DOI: 10.23736/S0392-9590.18.03996-2
  25. Bartelin M.L., Camm A.J., Lüscher T.F., Maurer G. Epidemiology and risk factors. ESC CardioMed. 2018; 1–12: 2018. DOI: 10.1093/med/9780198784906.001.0001
  26. Emdin C.A., Anderson S.G., Callender T., Conrad N. et al. Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults. BMJ. 2015. DOI: 10.1136/bmj.h4
  27. Knuuti J., Wijns W., Saraste A., Capodanno D., Barbato E., Funck-Brentano C. et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur. Heart J. 2020; 41: 407–77. DOI: 10.1093/eurheartj/ehz425
  28. Criqui M.H., Aboyans V. Epidemiology of peripheral artery disease. Circ. Res. 2015; 116 (9): 1509–26. DOI: 10.1161/circresaha.116.303849
  29. Joosten M.M., Pai J.K., Bertoia M.L., Rimm E.B., Spiegelman D., Mittleman M. et al. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA. 2012; 308 (16): 1660. DOI: 10.1001/jama.2012.13415
  30. Allison M.A., Criqui M.H., McClelland R.L., Scott J.M. The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arterial disease in the multi-ethnic study of atherosclerosis (MESA). J. Am. Coll. Cardiol. 2006; 48 (6): 1190–7. DOI: 10.1016/j.jacc.2006.05.049
  31. Aronow W.S. Drug treatment of peripheral arterial disease in the elderly. Drugs Aging. 2006; 23 (1): 1–12. DOI: 10.2165/00002512-200623010-00001 32. Newman A.B., Siscovick D.S., Manolio T.A., Polak J., Fried L.P., Borhani N.O. et al. Ankle-arm index as a marker of atherosclerosis in the cardiovascular health study. Cardiovascular Heart Study Collaborative Research Group. Circulation. 1993; 88 (3): 837–45. DOI: 10.1161/01.cir.88.3.837
  32. Cosentino F., Grant P.J., Aboyans V., Bailey C.J., Delgado V., Federici M. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 2019. DOI: 10.1093/eurheartj/ehz486
  33. Stevens J.W., Simpson E., Harnan S., Squires H., Meng Y., Thomas S. et al. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br. J. Surg. 2012; 99 (12): 1630–8. DOI: 10.1002/bjs.8895 35. Bedenis R., Stewart M., Cleanthis M., Robless P., Mikhailidis D.P., Stansby G. et al. Cilostazol for intermittent claudication. Cochrane Database of Systematic Reviews. 2014; Issue 10. DOI: 10.1002/14651858.cd003748.pub4
  34. Santilli S.M. The coronary artery revascularization prophylaxis (CARP) Trial: results and remaining controversies. perspectives in vascular surgery and endovascular therapy. 2006; 18 (4): 282–5. DOI: 10.1177/1531003506295144
  35. Duran N.E., Duran I., Gürel E., Gündüz S., Gol G., Biteker M. et al. Coronary artery disease in patients with peripheral artery disease. Heart Lung J. Acute Crit. Care. 2010; 39 (2): 116–20. DOI: 10.1016/j.hrtlng.2009.07.004
  36. Nordanstig J., Taft C., Hensater M., Perlander A., Österberg K., Jivega°rd L. et al. Improved quality of life after 1 year with an invasive versus a noninvasive treatment strategy in claudicants: one-year results of the invasive revascularization or not in intermittent claudication (IRONIC) trial. Circulation. 2014; 130 (12): 939–47. DOI: 10.1161/circulationaha.114.009867
  37. Gerhard-Herman M.D., Gornik H.L., Barrett C., Barshes N.R., Corriere M.A., Drachman D.E. et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation. 2016; 135 (12): 686–725. DOI: 10.1161/cir.0000000000000470
  38. McFalls E.O., Ward H.B., Moritz T.E., Goldman S., Krupski W.C., Littooy F. et al. Coronaryartery revascularization before elective major vascular surgery. N. Eng. J. Med. 2004; 351 (27): 2795–804. DOI: 10.1056/nejmoa041905
  39. Landesberg G., Mosseri M. PRO: preoperative coronary revascularization in high-risk patients undergoing vascular surgery. Anesth. Analg. 2008; 106 (3): 759–63. DOI: 10.1213/ane.0b013e3181685054
  40. Raghunathan A., Rapp J.H., Littooy F., Santilli S., Krupski W.C., Ward H.B. et al. Postoperative outcomes for patients undergoing elective revascularization for critical limb ischemia and intermittent claudication: a subanalysis of the coronary artery revascularization prophylaxis (CARP) trial. J. Vasc. Surg. 2006; 43 (6): 1175–82. DOI: 10.1016/j.jvs.2005.12.069
  41. Monaco M., Stassano P., Di Tommaso L., Pepino P., Krupski W.C., Ward H.B. et al. Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients. J. Am. Coll. Card. 2009; 54 (11): 989–96. DOI: 10.1016/j.jacc.2009.05.041
  42. Alekyan B.G., Pokrovskiy А.V., Karapetyan N.G., Chupin A.V., Varava A.B., Knysh Yu.B. et al. Hospital results of endovascular treatment for combined lesions of intermittent claudication and coronary artery disease. Russian Journal of Endovascular Surgery. 2020; 7 (2): 130–7. DOI: 10.24183/ 2409-4080-2020-7-2-130-137 (in Russ.)

About Authors

  • Bagrat G. Alekyan, Dr. Med. Sc., Professor, Academician of RAS, Deputy Director, ORCID
  • Narek G. Karapetyan, Cand. Med. Sc., Senior Researcher, Endovascular Surgeon, ORCID
  • Marat A. Sedgaryan, Postgraduate, Endovascular Surgeon, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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