Surgical treatment of occlusive and stenotic lesions of extracranial arteries and aorto-ilio-femoral segments at chronic critical ischemia

Abstract

Introduction. To date, the issues of surgical tactics remain unresolved, namely, the choice of volume and area of primary reconstruction with occlusion-stenotic lesions of extracranial arteries and aorto-ilio-femoral segment at chronic critical ischemia. The aim of the study. Improve the results of surgical treatment of combined occlusion-stenotic lesions of extracranial arteries and aorto-ilio-femoral segments at of chronic critical ischemia. Materials and methods. The study included 31 patients with associated lesions of extracranial arteries and aorto-iliofemoral segments. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disorders, ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. In the system of preoperative preparation the proposed complex of prevention of reperfusion-reoxygenative complications was introduced. Results and discussion. The decision of the order of restorative operations on the brachiocephalic arteries and the aortoilio- femoral segment was based on the analysis of the localization of the occlusive process in both arterial basins, their hemodynamic characteristics, the degree of ischemia and the tolerance of the brain to ischemia. In connection with the widespread occlusion-stenotic lesion of extracranial arteries in combination with the stenotic process of the contralateral internal carotid artery, in the stage of relative compensation of cerebral blood flow in 6 patients, primarily surgical intervention on the neck vessels was performed. In 25 patients, one-time surgical intervention was performed on the extracranial arteries and the aorto-ilio-femoral segments. Analyzing the results of revascularization operations, it can be argued that a differentiated approach to choosing the tactics of surgical treatment of multifocal atherosclerotic lesions of arterial pools should be used. Conclusions First of all, revascularization of the neck vessels during multifocal lesions of extracranial arteries and relative compensation of cerebral blood flow is performed, and in the second place reconstructive surgical intervention is performed on the aorto-club-femoral basin; in the occlusion-stenotic process of the internal carotid artery one-stage surgical intervention is performed on the extracranial arteries and the aorto-ilio-femoral segment at chronic critical ischemia.