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Хроническая ишемия, угрожающая потерей конечности: современное состояние проблемы

Я. И. Бибиков, А. Ч. Шулейко, Г. В. Бут-Гусаим УЗ «Минская ордена Трудового Красного Знамени областная клиническая больница», Лесной, Республика Беларусь, УО «Белорусский государственный медицинский университет», Минск, Республика Беларусь
DOI:  https://doi.org/10.51922/1818-426X.2026.3.38
2026 №3 | Обзоры
Аннотация
Список литературы
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Хроническая ишемия, угрожающая потерей конечности (ХИУПК), представляет собой клинический синдром при наличии заболевания периферических артерий нижних конечностей, который ассоциирован с высоким риском большой ампутации и летальности. В последние годы произошёл пересмотр устоявшихся взглядов на данную патологию, что связано с накоплением новых данных и подходах к лечению. Целью настоящего литературного обзора явился анализ эволюции терминологических подходов, современных методов диагностики, классификационных систем и результатов различных стратегий хирургического лечения пациентов с ХИУПК.
В работе обоснована необходимость перехода от устаревшего понятия «критическая ишемия нижних конечностей» (КИНК) к более современной и клинически значимой концепции ХИУПК, которая охватывает более широкий спектр пациентов. Проведен детальный анализ современных методов диагностики, включая неинвазивные и инвазивные ангиографические методики. Особое внимание уделено классификационным системам, применяемым в практике у пациентов с заболеваниями периферических артерий, в первую очередь шкале WIfI (Wound, Ischemia, foot Infection) и системе GLASS (Global Limb Anatomic Staging System).
В работе систематизированы данные литературы о результатах различных стра- тегий хирургического лечения пациентов с ХИУПК, включая открытые шунтирующие операции, эндоваскулярные вмешательства и гибридные подходы. Рассмотрены факторы, влияющие на клинический исход реваскуляризации: характер поражения артериального русла, исходное состояние конечности и общее состояние пациента. Отдельно проанализированы факторы риска сохранения конечности и долгосрочной выживаемости пациентов. В обзоре продемонстрировано, что, несмотря на достигнутые успехи, многие вопросы остаются дискутабельными. Проведение дальнейших исследований с учётом более развёрнутых клинических и анатомических параметров позволит получить новые научные знания, оптимизировать алгоритмы лечения и улучшить оказание медицинской помощи пациентам с ХИУПК.
Ключевые слова:
периферические артерии, хроническая ишемия, нижняя конечность, угроза ампутации, ангио визуализация, реваскуляризация
Chronic limb-threatening ischemia: state-of-the-art review problem

Chronic limb-threatening ischemia (CLTI) is the clinical syndrome in the presence of the peripheral lower extremities arteries disease which is associated with a high risk of major amputation and mortality. In recent years there has been a revision of established views on this pathology which is connected with the accumulation of new data and approaches to treatment. The purpose of this literature review was to analyze the evolution of terminological approaches, modern methods of diagnosis, classification systems and results of various strategies of surgical treatment of patients with CLTI.
The article substantiates the need to move from the outdated concept of “critical ischemia of the lower extremities” to a more modern and clinically relevant concept of CLTI which covers a wider range of patients. A detailed analysis of modern diagnostic non-invasive and invasive methods was carried out. Special attention was paid to the classification systems used in practice in patients with peripheral artery disease, primarily the WIfI scale (Wound, Ischemia, foot Infection) and the GLASS system (Global Limb Anatomic Staging System).
This work systematizes literature data on the results of various strategies of surgical treatment of patients with CLTI including open, endovascular and hybrid operations. Factors affecting the clinical outcome of revascularization are considered: the nature of the arterial lesions, the initial condition of the limb and the patient related factors. Risk factors for limb preservation and long-term patient survival are analyzed separately. The review shows many issues remain debatable despite the achieved success. Conducting further studies taking into account more detailed clinical and anatomical parameters will allow to obtain new scientific knowledge, optimize treatment algorithms and improve the provision of medical care to patients with CLTI.

Keywords
peripheral arteries, chronic ischemia, lower limb, threat of amputation, angiographic imaging, revascularization
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