Limb Ischemia Clinical Trial
Official title:
Characteristics and Prognosis of Patients With Critical Ischemia at High Risk of Amputation Managed by Endovascular Bypass: a Retrospective Study of 15 Patients
Obliterative arterial disease of the lower limbs (AOMI) is associated with a high risk of
cardiovascular events, with a linear relationship between a fall in the systolic pressure
index and a risk of cardiovascular morbidity and mortality. Critical ischemia is the most
severe stage of AOMI, associated with decubitus pain and / or foot ulceration. The severity
of this arterial involvement involves functional prognosis of the lower limb with a high risk
of amputation, as well as the patient's vital prognosis. In these patients, the rate of
amputation and mortality at 1 year can reach 20%. Consequently, the goal of management in a
multidisciplinary setting is threefold: the treatment of pain, improvement of the functional
prognosis and improvement of the patient's vital prognosis. Revascularization should be
attempted as often as possible for the purpose of limb salvage and improvement of patient
survival.
In the vascular medicine department, the indication and modalities of the revascularization
procedure are discussed at a multidisciplinary consultation meeting. The
medical-radiological-surgical expertise takes into consideration the patient's terrain and
comorbidities and the technical possibilities according to the arterial damage. With the
modernization and development of endovascular equipment dedicated to the hamstrings, the
interventional radiology techniques in the management of critical ischemia allow the
treatment of one or more arterial axes as well as a very distal revascularization in the
arteries. foot with a lower morbidity-mortality compared to surgery, especially in the most
fragile patients. Since 2013, the endovascular revascularization procedures performed by the
interventional radiology team have been an integral part of the management of patients with
critical ischemia hospitalized in the vascular medicine department.
In patients with critical ischemia at high risk of major amputation and without the option of
traditional endovascular or surgical revascularization, an endovascular revascularization
technique for leg rescue is discussed as a last resort in multidisciplinary staff. This
technique, performed by the interventional radiology team (MDP and GA), consists of an
extra-anatomic endovascular femoro-popliteal bypass. We wish to describe the limb salvage
rate and the preservation of autonomy in the 15 patients treated with this revascularization
technique since 2013 in the vascular medicine department of the GHPSJ.
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