RECONSTRUCTION OF THE CAROTID BASIN IN THE CONDITIONS OF DEVELOPMENT OF LATE COMPLICATIONS AFTER REVASCULARIZATION OF THE AORTO-FEMORAL SEGMENT
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2020.3.11515Keywords:
obliterating atherosclerosis, arterial reconstruction, carotid endarterectomy, revascularizationAbstract
Summary. Among patients with atherosclerotic occlusion of the terminal aorta and main arteries of the lower extremities, the frequency of the brachiocephalic arteries lesions is 40–72 %.
The aim of the study – to improve the results of treatment of patients with atherosclerotic lesions of the extracranial arteries in the development at distant complications after revascularization of the aorto-iliac-femoral segment.
Materials and Methods. Among 522 patients operated in 2006–2019 for atherosclerotic occlusion of the aorto/iliac-femoral zone in the remote postoperative period 148 (28.35 %) late complications were diagnosed. Among them, atherosclerotic lesions of the internal carotid artery (ICA) were found in 132 (89.19 %). The
nature of atherosclerotic lesions, the degree of occlusive process and the state of cerebral hemodynamics were determined using an ultrasonograph "Siemens Acuson S2000, magnetic resonance imaging Tesla Excelart Vantage Toshiba Medical System, computed tomography Philips Brilliance 64.
Results. Patients with atherosclerotic lesions of the extracranial arteries showed asymptomatic course in 61 (70.12 %) cases, transient ischemic attack – in 17 (20.99 %) people. Stroke was diagnosed in 2 (2.30 %) patients. 43 (49.43 %) – classical carotid endarterectomies, 23 (26.44 %) – retrograde carotid endarterectomies, and 11 (12.64 %) – eversion carotid endarterectomies were performed during surgical correction of blood flow through the internal carotid artery. In 8 observations (9.19 %) stenting of the internal carotid artery was performed. After carotid endarterectomy, 85 patients underwent surgery for long-term complications of surgical treatment of the aorto-femoral arterial segment. In 78 (91.76 %) cases, repeated reconstructive surgery of late complications was performed simultaneously with carotid endarterectomy. The next stage of surgical treatment was surgery for various forms of late complications of reconstruction of the aorto-femoral arterial segment. 8 (9.41 %) thrombosis of reconstructed segments was diagnosed. Repeated surgeries in 2 observations were unsuccessful and they had amputation of the lower limb.
Conclusion. Performing carotid endarterectomy in combination with surgical treatment of distant complications of revascularization of the aorto-femoral arterial segment made it possible to prevent the development of neurological complications and achieve good results in 94.1 %. in the surgical treatment of the combined atherosclerotic lesions of ICA and remote complications reconstruction of atherosclerotic operations occlusion of the aorto-iliac-femoral arterial zone.
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