Hybrid surgical treatment of chronic limb ischemia in patients with stenotic-occlusive process of infrainguinal arterial segment
Keywords:
chronic limb ischemia; atherosclerosis; hybrid surgery; infrainguinal segment; revascularization.Abstract
Introduction. Hybrid surgical technologies are one of the methods of treatment in patients with stenotic-occlusive process of the lower limbs [8, 9]. At the same time X-ray endovascular reconstruction of one arterial segment is supplemented bypass operation of another one [10]. The aim of the study. To improve the results of surgical revascularization of chronic limb ischemia infrainguinal arterial segment in the conditions of stenotic-occlusive process of the tibial arteries. Materials and methods. Hybrid surgical treatment on the infrainguinal arterial segment with stenotic-occlusive process of the tibial arteries was performed in 74 patients. Duplex ultrasound scanning and vascular contrast-enhanced computed tomography were used to determine the prevalence rate of stenotic-occlusive process of femoral-poplitea-tibialis arterial segment. Results. 74 hybrid surgical interventions on the infrainguinal arterial segment of the lower extremities were performed simultaneously in two stages. At the first stage, a femoral-popliteal autovenous bypass with a distal anastomosis at the border of the popliteal artery (62 observations) and tibio-peroneal trunk (12 observations) were formed. In the second stage, 74 endovascular surgical interventions were performed on the tibial arteries. Angioplasty of only one of the tibial arteries was performed in 45 (60.81%) cases, and two arteries at the same time in 29 (39.19%) cases. The anterior tibial artery (ATA) was most often subjected to endovascular manipulations in 45 (60.81%) cases, the posterior tibial artery (PTA) in 32 (43.24%) cases, less often the peroneal artery – in 26 (35.13%) patients. Moreover, the peroneal artery was most often (80.77%) subjected to endovascular revascularization in a pair with ATA (52.38%) and PTA (47.62%). Discussion. Direct results of hybrid surgical interventions indicate that during 30 days of the early postoperative period, the patency of the reconstruction areas is preserved in 69 (93.24%) patients. Thrombosis of the hybrid bypass reconstruction developed in 5 (6.76%) cases. Long-term results of hybrid surgeries in 69 patients were followed for 36 months. During the observation period, 8 (11.59%) were diagnosed with thrombosis of the reconstruction segment. Most often this happened in the period of 3 months of the remote postoperative period – 3 observations and in the period of 6 months – 2 cases. Conclusion. Hybrid surgical treatment on the infrainguinal arterial segment in the conditions of occlusivestenotic process of the tibial arteries shown highly efficiency, giving the chance to keep in the early postoperative period passability of reconstruction segment at 93,24% of patients and at three-year supervision to reach cumulative preservation of the lower extremity at 82,61% of patients, and patency of a area of reconstruction – at 68,12% of supervision.
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