Surgical tactics in the combined stenotic-occlusive lesion of the extracranial arteries and aorto/ilio-femoral region
DOI:
https://doi.org/10.11603/2414-4533.2019.3.10542Keywords:
revascularization, extracranial arteries, aorto/iliac-femoral segmentAbstract
The aim of the work: to prevent the development of neurological complications in the surgical treatment of combined atherosclerotic lesions of the extracranial arteries and the aorto/ilio-femoral zone.
Materials and Methods. A total of 133 patients with combined stenotic-occlusive lesions of the extracranial arteries (ECA) and the aorto/iliac-femoral segment (AIFS) were examined and operated on. 102 patients were diagnosed with various options for atherosclerotic occlusion of AIFS. Problem lower extremity in the indicated group of patients in 64 cases was characterized by III-IV stages. Chronic critical lower limb ischemia (CCLLI) in 33 – stage IIIA in 7 – stage IIB, chronic arterial insufficiency (CAI) (according to the classification of Fontaine R. taking into account the criteria of the European working group 1992), contralateral lower extremity – stage IIB CAI. 29 patients were diagnosed with various variants of atherosclerotic occlusion of the ilio-femoral arterial bed. The lower limb with occlusion of the ileal-femoral segment in 15 observations was characterized by stage IIB CAI, in 16 – stage IIIA CAI, contralateral lower extremity – stage IIA CAI.
In 133 patients, the ECA occlusive stenotic process was diagnosed. Isolated lesion of the internal femoral artery (IFA) was diagnosed in 94 cases, common femoral artery (CFA) – in 25 patients. In 81 of them, it was combined with the stenotic process at the level of 22 – 34 % of contralateral IFA. The occlusive-stenotic process in the BCS and the bifurcation of the OCA and the ICA are diagnosed in 12 cases. In two patients, OCA bifurcation stenosis was combined with PKA occlusion. In 51 (38.4 %) the compensated stage of cerebral circulatory failure was established, in 82 (61.7 %) observations – the stage of relative compensation.
Results and Discussion. When conducting reconstructive surgery with simultaneous occlusive-stenotic lesions of ECA and A/IFS, surgical tactics were applied in which simultaneous surgical intervention is performed on both arterial zones, taking into account the dominant lesion of one of the arterial system and possible postoperative transformation of central hemodynamics
When performing reconstructive restorative operations with simultaneous occlusive-stenotic lesion of ECA and A/IFS, the early postoperative period was characterized by the development of transient ischaemic attack (TIA) in 12 (9.2 %) cases, rhythm and conduction disturbance of the heart muscle – in 10 (7.5 %) cases, transient renal failure – in 11 (8.3 %) cases and interstitial pulmonary edema – in 2 (1.5 %).
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