ANALYSIS OF REPEAT LOWER LIMB REVASCULARISATION FAILURES IN PATIENTS WITH CHRONIC LIMB ISCHAEMIA

Introduction. The natural course of the disease in intermittent claudication and critical limb ischaemia differs significantly, which is an important factor in choosing a treatment strategy. Aim. To analyse the clinical outcomes of unsuccessful primary and repeat revascularisation in patients with chronic limb ischaemia following reocclusion of the reconstructed arterial segment, and to evaluate the outcomes of lower limb amputations. Materials and methods. A retrospective analysis was performed of the treatment outcomes of 119 patients with occlusive-stenotic lesions of the lower limb arteries who underwent open and endovascular interventions for revascularisation in chronic limb ischaemia over a 2-year period. In 103 (86.5%) patients, reocclusion of the reconstructed segment developed in the postoperative period, which necessitated repeated revascularisation or amputation. Two groups were formed: the first consisted of 17 patients after primary revascularisation who underwent amputation due to the absence of ischaemia regression; the second consisted of 31 patients after repeated revascularisation who, despite the intervention, developed progressive ischaemia requiring amputation. An analysis was performed of the timing and level of amputations, the frequency of complications, and the influence of concomitant pathology. Results. In the group of patients who underwent repeat revascularisation, amputations were more often performed at a later date: more than 1 year in 29% of cases compared to 5.8% in the group of primary interventions. The main causes of limb loss after repeat reconstructions were shunt thrombosis, vascular prosthesis infection, false aneurysms, and bleeding. High amputations at the hip level prevailed (59.3%). Diabetes mellitus and cerebrovascular disease were associated with a higher risk of limb loss, but no statistically significant differences between the groups in the frequency of these conditions were found. Conclusions. Repeated revascularisation in cases of arterial reocclusion in patients with chronic limb ischaemia allows amputation to be postponed in some patients and prolongs limb preservation, but is accompanied by a high risk of severe vascular complications, necessitating major amputations. Optimisation of patient selection and choice of revascularisation tactics are key to improving treatment outcomes and limb preservation.