Ján Tomka, Roman Necpal, Katarína Vavrovičová, Zoroslav Zita, Vladimír Šefránek
For the treatment of patients with peripheral arterial disease (PAD) and with critical limb ischaemia (CLI), following options exist: endovascular procedure, vascular surgery or combination of both – hybrid procedure. Angiosurgery should be performed after complex vascular examination. It is reasonable to come to common consensus on indication of vascular specialists – vascular surgeon, angiologist, interventional radiologist, the aim of which is to find out the most optimal way of treatment. The goal of the article is to present possible options of surgical treatment for patients with peripheral arterial disease, especially for those with critical limb ischaemia and to show what the indications for interventions are on the basis of current recommendations. All patients should be indicated for surgery respecting TASC II guidelines (Inter-Society Consensus for the Management of Peripheral Arterial Disease, 2007) which define 4 categories TASC A, B, C and D according to length and number of atherosclerotic stenoses, separately in aorto-iliac and femoro-popliteal locations. In aorto-iliac region, endovascular treatment is indicated primary for TASC A and B lesions, while in TASC C lesions the decision between endovascular and surgical therapy should be made according to number of patient´s comorbidities (consider also individual patient preference). Surgery is fully justifiable for TASC D aorto-iliac lesions (multiple, bilateral lesions/occlusions). In femoro-popliteal area, as EUSC classification displays, endovascular therapy is indicated for TASC A and B lesions, open-surgery for TASC C and D lesions (extensive lesions more than 15 cm long). Primary surgical treatment is eligible for localised atherosclerotic lesions in femoral region – in the site of common femoral artery – arteria femoralis communis (AFC).