Endovascular angioplasty of the tibial arteries at repeated revascularization of the infrainvaginative arterial bed of the lower limbs

Abstract

During 2006 – 2019 were monitored the results of surgical treatment of 522 patients. 353 patients with bilateral atherosclerotic occlusion of the aorto-femoral zone and 159 patients with unilateral occlusive process of the iliac-femoral segment were subjected to surgery. At the time of initial surgery, 228 patients were diagnosed with ChAI IIIA stage. (according to the Fontaine R. classification, taking into account the criteria of the European Working Group (1992)), in 189 – ChCILE IIIB-IV stage, in 98 – ChAI IIB stage, In 92 (17,6%) patients hemodinamicaly significant stenosis of the etracranial arteries was diagnosed, 75 of this patients underwent surgery on the vessels of the neck. In the distant postoperative period we diagnosed 146 (27.97%) late complications, of which 78 (56.1%) had recurrence of chronic arterial insufficiency. 78 patients underwent surgical treatment. The most common surgical procedure in these conditions were reshunting operations. When performing the reshunting, the proximal anastomosis of the aloshunt was formed at the level of the distal anastomosis of the pre-formed aorta/iliac-femoral aloshunt. Revascularization of the outflow pathways of the arterial bed of the tibial segment was achieved by the use of popliteal-tibial autovenous bypass and endovascular balloon angioplasty. There were 19 popliteal-tibial autoveneous bypass grafts, of which 15 popliteal-PTA autoveneous bypass grafts and 4 popliteal-ATA autoveneous bypass grafts. Performed 30 endovascular angioplasty, In 19 observations simultaneously performed endovascular balloon angioplasty of two tibial arteries. Thus, the velocity of the volumetric blood flow in the deep arterial arch was acheived at the level of 3-4 cm/sec, and in the superficial arterial arch at the level of 5-7 cm/sec. The postoperative period in 10 (12.8%) patients was complicated by the thrombosis of the reconstruction segment. In 7 observations thrombosis of the reconstruction segment was eliminated. At re-revascularization of the infrainvaginative arterial bed in conditions of recurrence of chronic arterial insufficiency we received a satisfactory result of surgical treatment in 87,2% of observations.