Analysis of risk factors for hemorrhagic complications in patients with chronic limb threatening ischemia

Maхimkin D.A., Khalabuzar V.A., Faybushevich A.G., Gitelzon E.A.

Backgraund: hemorrhagic complications develop with a frequency of 2.0 to 10.5% of cases in the perioperative period in the group of patients with chronic limb threatening ischemia (CLTI). Identification of risk factors for hemorrhagic complications will reduce the frequency of their occurrence by planning surgical tactics and medical support for the patient, as well as associated complications.

Aims: identification and analysis of risk factors for bleeding in the perioperative period in patients with chronic limb threatening ischemia.

Methods: a retrospective analysis of the medical histories and outpatient records of 766 patients with chronic limb threatening ischemia who underwent surgical treatment (from 2006 to 2020) in order to identify hemorrhagic complications and possible risk factors for their development. All patients undergoing surgery for CLTI were included in the study. Exclusion criteria were: acute coronary syndrome, acute ischemia of the lower extremities, stroke, diabetes mellitus type I, severe purulent-necrotic lesions of the lower extremity requiring amputations. Observation period: in-hospital.

Results: 44 (5.74%) episodes of hemorrhagic complications in the early postoperative period. During the binary logistic regression, the most significant factors were: endovascular intervention with brachial and femoral access (p = 0.0001), hybrid intervention (p = 0.0001), duration of surgical intervention over 60 minutes (p = 0.001), triple antithrombotic therapy (p = 0.001), pronounced calcification of the vascular wall (p = 0.023).

Conclusions: identifying the most common risk factors for hemorrhagic complications through a comprehensive analysis of clinical, demographic and instrumental data, as well as studying their impact on the prognosis of patients with CLTI, makes it possible to develop a personalized approach to the treatment of such patients and prevent the development of these complications.

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