CAUSES OF THROMBOSIS AT THE REMOTE POSTOPERATIVE PERIOD OF RECONSTRUCTION OF THE AORTIC/ILIAC-FEMORAL ARTERIAL SYSTEM
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2020.3.11415Keywords:
repeated revascularization, thrombosis of arteries and shunts, chronic arterial insufficiency, reconstructive operationsAbstract
Summary. The main reason for the development of complications of the late postoperative period in patients after reconstructive interventions on the main arteries of the lower extremities is the progression of uncorrected atherosclerotic process. The most common complications of the remote postoperative period include thrombosis of arteries and shunts, anastomotic false aneurysms, infectious complications with the spread of the process to vascular explants. Along with this, a number of long-term complications are diagnosed, which develop as a result of not using some methods and techniques of surgical intervention as part of reconstructive operations on the main arteries.
The aim of the study – to determine the causes of thrombosis in the remote postoperative period of reconstruction of the aortic/iliac-femoral basin and, consequently, suggest the scope of revascularization of the aortic/iliac-femoral basin in order to prevent their development.
Materials and Methods. In 2006–2019, 522 patients underwent surgical treatment for atherosclerotic occlusion of the aortic/iliac-femoral system. In the remote postoperative period, 148 (28.35 %) delayed complications were diagnosed, of which late thrombosis of the reconstruction segment was detected in 47 (33.81 %) cases. Among them, in 37 cases late thrombosis of the aortic/iliac-bifemoral alloprosthesis, in 4 patients late thrombosis of the branch of aortic/iliac-bifemoral alloprosthesis and corresponding deep femoral artery, in 6 patients thrombosis of the iliac-femoral segment of the contralateral lower extremity were diagnosed.
Results. Late thrombosis of the reconstruction segment was detected in 47 (33.81 %) cases. Some reasons for the development of thrombosis of the remote postoperative
period are presented, in which there is a progression of the atherosclerotic process, especially in certain segments of the arterial bed, which were not covered by surgery. These included 4 observations with late thrombosis of the branch of aortic/iliac-bifemoral alloprosthesis and the corresponding
deep femoral artery and 6 observations with thrombosis of the iliac-femoral segment of the contralateral lower extremity. Taking into account the level of stenotic process of the iliac-femoral segment of the contralateral lower extremity in the first case and determining the peak systolic velocity (PSV) and resistance index (RI) at the level of deep femoral artery and tibioperoneal trunk (TPT) in the second one, under the conditions of inclusion of the arterial segments into the scope of revascularizing intervention, the development of late thrombosis of these segments can be prevented.
Conclusions. The development of late thrombosis in the arteries of the main segments can be prevented by including them in the scope of revascularizing intervention.
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