[Rotational atherectomy for acute and chronic lower limb ischemia].

Abstract

As the standard of living improves, the incidence of diabetes, atherosclerosis and hypertension increases, which causes an increase in ischemic lesions of the arteries of the lower extremities. Clinical manifestations depend on the cause and the presence of the patient's underlying peripheral arterial disease. Treatment of lower extremity ischemia remains a challenge for vascular surgeons. For many years, the mainstay of treatment was surgical or catheter-based thrombectomy and bypass surgery. Later, thrombolytic therapy and percutaneous transluminal angioplasty became treatment options for some patient groups. Despite these advances in treatment, lower extremity ischemia is still associated with high rates of morbidity, mortality, and limb loss. Therefore, regardless of which treatment method is used, early diagnosis and prompt surgical intervention based on individual symptoms is essential, with the goal always being to reduce pain and improve blood flow to ultimately save the limb. When choosing a treatment option for lower extremity ischemia, the risks of a particular intervention relative to the patient's clinical condition must be weighed against the urgency and severity of the threat to the limb and the expected improvement in the patient's clinical condition. One of the modern technologies for endovascular surgical treatment of peripheral vascular disease is rotational atherectomy. Quite a large number of studies devoted to this technology have been conducted, but the results obtained confirming or questioning the effectiveness of innovative systems of rotational atherectomy at the present stage of vascular surgery development are still insufficiently generalized.

Objective: To summarize the review of modern studies, clarifying the obtained results of the effectiveness of innovative systems of rotational atherectomy in acute and chronic ischemia of the lower limbs.

It was clarified that Rotarex and Jetstream rotational atherectomy systems allow to effectively restore blood circulation in chronic thrombosis, including atherosclerotic and diabetic arterial lesions, which allows us to recommend them for further use in patients taking into account the indications and individual features of the course of ischemic limb lesions. Although various studies have proven the safety and efficacy of rotational atherectomy, there are limitations, so careful patient selection is required and further large-scale studies are needed.