Evaluation of long-term treatment results of patients with critical limb ischemia and diabetes mellitus with different management approaches
- Authors: Kalinin R.E1, Suchkov I.A1, Krylov A.A1,2, Mzhavanadze N.D1, Pshennikov A..1,2, Vinogradov S.A2, Solyanik N.A.1, Karpov V.V2
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Affiliations:
- Ryazan State Medical University
- Ryazan State Clinical Hospital
- Issue: Vol 103, No 1 (2022)
- Pages: 23-34
- Section: Theoretical and clinical medicine
- Submitted: 14.09.2021
- Accepted: 26.01.2022
- Published: 07.02.2022
- URL: https://kazanmedjournal.ru/kazanmedj/article/view/80090
- DOI: https://doi.org/10.17816/KMJ2022-23
- ID: 80090
Cite item
Abstract
Background. In all cases of critical lower limb ischemia revascularization should be performed. However, the overlay of diabetic angiopathy significantly worsens the prognosis of the surgery, and the conservative therapy also frequently turns out to be ineffective even in the nearest future. Therapeutic stimulation of angiogenesis in this group of patients is an additional application point for the possible improvement of treatment results.
Aim. Evaluating treatment results of patients with critical ischemia and underlying diabetes after 5 years from the beginning of supervising, as well as assessing the benefits of additional angiogenesis as a part of treatment.
Material and methods. The study included data from 140 patients with critical ischemia and diabetes mellitus, divided into 4 groups, who received surgical [groups IA (n=45) and IB (n=30)] or therapeutic [groups IIA (n=40) and IIB (n=25)] treatment. Additional angiogenic therapy was also carried out in two groups (groups IB and IIB). Treatment outcomes were assessed over a 5-year period. Efficacy criteria were evaluated in the form of limb preservation and patient survival. The results were studied using descriptive statistics methods. Qualitative data were analyzed by constructing 2×2 contingency tables and using the xi-square method.
Results. The best indices of limb preservation and the lowest mortality of patients were obtained in the group after revascularization with additional angiogenic therapy. Gene therapy induction significantly improved the course of disease in limb preservation for periods from 6 months to 2 years (30% amputations by 2 years of follow-up, p=0.045). Angiogenic induction of angiogenesis also made it possible to improve the treatment results in the groups of conservative therapy but reliably better indicators of limb preservation were obtained in two groups with surgical interventions.
Conclusion. The optimal management tactic for patients with critical lower limb ischemia and underlying diabetes mellitus is direct revascularizing intervention on the lower limb arteries with additional angiogenic therapy in the postoperative period. Additional gene therapy induction of angiogenesis makes it possible to reduce the number of amputations both as part of combined surgical or therapeutic treatment , but it cannot be an alternative to surgery.
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About the authors
Roman E Kalinin
Ryazan State Medical University
Email: kalinin-re@yandex.ru
ORCID iD: 0000-0002-0817-9573
MD, D.Sc. (Med.), Prof., Rector, Head, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiology
Russian Federation, Ryazan, RussiaIgor A Suchkov
Ryazan State Medical University
Email: suchkov_med@mail.ru
ORCID iD: 0000-0002-1292-5452
MD, D.Sc. (Med.), Prof., Vice-Rector for Research and Innovative Development, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiology
Russian Federation, Ryazan, RussiaAndrey A Krylov
Ryazan State Medical University; Ryazan State Clinical Hospital
Author for correspondence.
Email: andrewkrylov1992@gmail.com
ORCID iD: 0000-0002-2393-0716
MD, Cand.Sc. (Med.), Assistant, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiological Diagnostics; Cardiovascular Surgeon, Depart. of Vascular Surgery
Russian Federation, Ryazan, Russia; Ryazan, RussiaNina D Mzhavanadze
Ryazan State Medical University
Email: nina_mzhavanadze@mail.ru
ORCID iD: 0000-0001-5437-1112
MD, Cand.Sc. (Med.), Assoc. Prof., Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiological Diagnostics
Russian Federation, Ryazan, RussiaAlexander S Pshennikov
Ryazan State Medical University; Ryazan State Clinical Hospital
Email: pshennikov1610@rambler.ru
ORCID iD: 0000-0002-1687-332X
MD, D.Sc. (Med.), Assoc. Prof., Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiological Diagnostics; Cardiovascular Surgeon, Depart. of Vascular Surgery
Russian Federation, Ryazan, Russia; Ryazan, RussiaSergey A Vinogradov
Ryazan State Clinical Hospital
Email: vsergey1993@icloud.com
ORCID iD: 0000-0001-8547-4798
Cardiovascular Surgeon, Depart. of Vascular Surgery
Russian Federation, Ryazan, RussiaNikita A. Solyanik
Ryazan State Medical University
Email: solianik.nikita@gmail.com
ORCID iD: 0000-0002-4667-3513
Clinical Resident, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiological Diagnostics
Russian Federation, Ryazan, RussiaVyacheslav V Karpov
Ryazan State Clinical Hospital
Email: sdrr@mail.ru
ORCID iD: 0000-0001-5523-112X
MD, Cand.Sc. (Med.), Cardiovascular Surgeon, Depart. of Vascular Surgery
Russian Federation, Ryazan, RussiaReferences
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