SURGICAL TREATMENT STRATEGIES IN PATIENTS WITH CRITICAL LIMB ISCHEMIA COMBINED WITH ISCHEMIC HEART DISEASE

Oktabr, 2025-Yil 56 SURGICAL TREATMENT STRATEGIES IN PATIENTS WITH CRITICAL LIMB ISCHEMIA COMBINED WITH ISCHEMIC HEART DISEASE Iriskulov Akbarjon Odilovich Republican Specialized Scientific and Practical Medical Center of Cardiology https://doi.org/10.5281/zenodo.17311070 Introduction: Critical limb ischemia (CLI) is a severe manifestation of peripheral arterial disease, often associated with ischemic heart disease (IHD). Mortality and morbidity remain high due to the systemic nature of atherosclerosis and perioperative cardiac complications. Optimizing treatment strategies in this group remains a clinical challenge. Materials and Methods: Analysis of clinical data and published studies was performed to evaluate outcomes of different revascularization approaches in CLI patients with coexisting IHD. Particular attention was given to the role of hybrid operations, routine coronary evaluation, and perioperative optimization. Results: The prevalence of IHD among CLI patients reaches 60–80%, and cardiovascular death is the leading cause of mortality, accounting for nearly half of all deaths. Coronary angiography before peripheral revascularization frequently reveals significant coronary stenoses, indicating the need for combined management. Studies demonstrate that staged or hybrid strategies, integrating open reconstruction of femoral arteries with endovascular iliac stenting, reduce operative trauma and perioperative cardiac events. In our analysis, all patients achieved relief of CLI, confirmed by pain regression and increased ankle-brachial index. In the bifurcation aorto-femoral bypass group, one patient developed myocardial infarction with subsequent renal failure, resulting in death, while several others experienced non-fatal coronary syndromes. In the hybrid group, acute coronary syndromes occurred but were managed conservatively without fatalities. Preoperative therapy including aspirin, statins, and beta-blockers for at least seven days contributed to perioperative stability. Conclusion: CLI patients with concomitant IHD remain at high surgical risk. Hybrid procedures and targeted preoperative preparation significantly reduce complications. Multidisciplinary approaches are essential to improve survival and long-term outcomes. Keywords: critical limb ischemia; ischemic heart disease; aorto-femoral bypass; hybrid surgery; revascularization; perioperative complications. References: 1. Акчурин Р.С. Хирургическое лечение больных с облитерирующим атеросклерозом и ишемической болезнью сердца. – М.: Медицина, 1995. 2. Покровский А.В., Абугов С.А. Клиническая ангиология. – М.: Медицина, 2010. 3. Суханов С.Г., Жуков В.П. Хирургия аорто-подвздошной зоны при критической ишемии. // Ангиология и сосудистая хирургия. – 2017. – Т.23, №2. – С. 15–22. Oktabr, 2025-Yil 57 4. Троицкий А.В., Кожевников В.Е. 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