С.В. Мшар, В. А. Янушко
УЗ «Брестская областная клиническая больница», Республиканский научно-практический центр «Кардиология», Минск
Облитерирующий атеросклероз артерий нижних конечностей занимает третье место в системе заболеваний сердечно-сосудистой системы. С возрастом отмечается увеличение заболеваемости облитерирующим атеросклерозом и в общей популяции составляет 3–5%. Наиболее сложной группой пациентов в лечении облитерирующего атеросклероза являются пациенты пожилого и старческого возраста. В настоящее время отмечается тенденция к увеличению продолжительности жизни и старению населения Республики Беларусь. Пациенты пожилого и старческого возраста с облитерирующим атеросклерозом характеризуются многоуровневым поражением и поражением дистальных отделов артериального русла, увеличением количества сопутствующей патологии, высоким риском сердечно-сосудистой смерти, обращением за медицинской помощью зачастую в стадии критической ишемии нижних конечностей. Пациенты высокого риска сердечно-сосудистых осложнений с перемежающей хромотой подлежат консервативному лечению, при развитии клиники критической ишемии нижних конечностей в связи с низкой эффективностью консервативных методов лечения стоит рассмотреть реваскуляризацию артерий нижних конечностей. Открытые хирургические методы лечения сопряжены с высоким риском осложнений и летальности. Рентгенэндоваскулярные методы лечения пациентов старшей возрастной группы характеризуются меньшим риском развития осложнений, меньшей травматичностью. Применение малотравматичных рентгенэндоваскулярных и гибридных методов лечения у пациентов пожилого и старческого возраста позволяет улучшить результаты лечения (снизить частоту ампутаций, уменьшить риск развития осложнений, улучшить качество жизни).
ключевые слова: облитерирующий атеросклероз, пожилой и старческий возраст, коморбидность, критическая ишемия нижних конечностей, рентгенэндоваскулярная хирургия, гибридная хирургия, ангиопластика, стентирование

для цитирования: С.В. Мшар, В. А. Янушко. Роль рентгенэндоваскулярной хирургии в лечении облитерирующего атеросклероза артерий нижних конечностей у пациентов пожилого и старческого возраста. Неотложная кардиология и кардиооваскулярные риски, 2020, Т. 4, № 2, С. 1069–1073

The role of x-ray endovascular surgery in the treatment of obliterating atherosclerosis of the lower extremity arteries in elderly and senile patients
S.V. Mshar, V.А. Yanushko
Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3–5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).
keywords: peripheral artery disease, elderly patient, comorbidity, critical limb ischemia, endovascular surgery, hybrid surgery, angioplasty, stenting

for references: S.V. Mshar, V.А. Yanushko. The role of X-ray endovascular surgery in the treatment of obliterating atherosclerosis of the lower extremity arteries in elderly and senile patients. Neotlozhnaya kardiologiya i kardioovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2020, vol. 4, no. 2, pp. 1069–1073

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