Phases of surgical interventions in patients with a combination of atherosclerotic lesions of the extracranial arteries, the terminal portion of the aorta and the lower extremity arteries
DOI:
https://doi.org/10.24144/2415-8127.2018.58.62-65Keywords:
atherosclerosis, carotid arteries, stroke, carotid endarterectomy, combined lesions of the terminal aorta and lower extremity vessels.Abstract
Introduction. According to literature, a combination of atherosclerotic lesions of the extracranial arteries, the terminal portion of the abdominal aorta and the lower extremity vessels occurs in 50-85% of patients. The aim of the study was to analyze the results of surgical treatment of patients with a combination of atherosclerotic lesions of the extracranial arteries, the terminal portion of the abdominal aorta and the main arteries of the lower extremities and to substantiate a differentiated surgical tactics of phasing arterial reconstructions. Materials and methods. There were evaluated the results of surgical treatment of 65 patients with a combination of atherosclerotic lesions of the extracranial arteries and other vascular territories. Results and discussion. In 7 patients with symptomatic ICA stenosis > 50% and 4 patients with asymptomatic ICA stenosis greater than 70% in case of contralateral ICA occlusion, carotid endarterectomy was performed first followed by the revascularization of the lower extremity vessels. In 7 patients with hemodynamically significant stenosis of the aortic arch branches, endovascular stenting was used. In the early postoperative period, acute cerebrovascular disease was observed in 2 (3.1%) patients; 1 (1.5%) patient died. Conclusions. In patients with symptomatic ICA stenosis >50% and hemodynamically significant ICA stenosis greater than 70% in case of contralateral ICA occlusion, it is recommended to start with carotid endarterectomy. In patients with critical limb ischemia and asymptomatic extracranial lesions, it is recommended to start with lower extremity revascularization.
References
Adraktas DD, Brasic N, Furtado AD Carotid atherosclerosis does not predict coronary, vertebral or aortic atherosclerosis in patients with acute stroke symptoms. Stroke. 2010;41(8):1604-9.
I. I. Kopolovets, P. Berek, V. V. Rusyn, P. O. Boldizhar, M. Frankovicova. The expediency of carotid endarterectomy up to 48 -72 hours after acute cerebrovascular disease in patients with symptomatic ICA stenosis more than 50%. Heart and Vessels 2018; 1: 40 – 43. [In Ukrainian].
Kochkina KV, Sidorenko AV, Myznikov AV, Usik GA, Shtark AA, Kochkina TA et al. Hybrid intervention for a multilevel aneurysmatic lesion of the aorta in a patient with multifocal atherosclerosis. Angiol Sosud Khir. 2017;23(4):55-9. [In Russian].
Butsko YS, Holiaka AH, Denysov SY, Horlenko FV, Rusyn VV, Boldizhar PO, et al. Symultanni endovaskuliarni vtruchannia pry poiednanomu arterosklerotychnomu urazhenni sonnykh arterii, aorty ta arterii nyzhnikh kintsivok. Naukovyi visnyk Uzhhorodskoho universytetu seriia «Medytsyna». 2017;1(55):89-94. [In Ukrainian].
Jung HJ, Lee SC, Kim KY, Lee SS. Simultaneous hybrid operation common femoral endarterectomy and endovascular treatment in multilevel peripheral arterial disease with critical limb ischemia. Indian J Surg. 2018 Apr;80(2):140-5. DOI: 10.1007/s12262-016-1570-2
Rusyn VI, Korsak VV, Levchak YA, Levytskyi AV, Butsko YS, Borsenko MI. Renthenkontrastni endovaskuliarni metody likuvannia syndromu pidkliuchychno-khrebtovoho obkradannia u patsiientiv z khronichnymy porushenniamy mozkovoho krovoobihu. Ukrainskyi Zhurnal Khirurhii. 2010;2:9-18. [In Ukrainian].
Nikulnikov PI, Ratushniuk AV, Beleiovych VV, Habriielian AV. Odnomomentni vtruchannia u khvorykh iz poiednanymy aterosklerotychnymy urazhenniamy koronarnykh ta sonnykh arterii. Klinichchna flebolohiia. 2016;9(1):21-23. [In Ukrainian].
Kovalchuk LY, Venher IK, Shkrobot LV. Hemodynamichne obhruntuvannia khirurhichnoi taktyky pry poiednanii okliuzii ekstrakranialnykh arterii ta terminalnoho viddilu cherevnoi aorty. Shpytalna khirurhiia. 2003;1:12-15. [In Ukrainian].
Kopolovets I.I., Frankovichova M., Berek P., Kubikova M., Boldizhar P.O., Rusyn V.V. Osoblyvosti khirurhichnoho likuvannia patsiientiv iz syndromom pidkliuchychno-khrebtovoho obkradannia. Shpytalna khirurhiia. 2017; 2 (78): 55 – 60.
Akhmedov AD, Usachev DY, Lukshyn VA. Karotydna endarterektomia u chvorych s vysokym khyrurhychnym ryzikom. Voprosy neirokhyrurhyy. 2013;77:36-41.
