Intraoperative status of the blood haemocoagulation system in patients with long-term complications of surgical treatment of atherosclerotic occlusion of the aorto/iliac-femoral zone
DOI:
https://doi.org/10.11603/2414-4533.2020.3.11459Keywords:
obliterative atherosclerosis, reconstructive surgery, recurrence of chronic arterial ischemia, alloprosthesis thrombosisAbstract
The aim of the work: to substantiate thromboprophylaxis at surgical interventions in patients with recurrence of chronic arterial insufficiency and late thrombosis of the aorto/iliac-bifemoral alloprosthesis and thrombosis of the iliac-femoral segment of the contralateral lower extremity.
Materials and Methods. Long-term results of surgical treatment of 522 patients during 2006–2019 were traced. 353 (67.62 %) patients were diagnosed with bilateral atherosclerotic occlusion of the aorto-femoral zone and 159 (30.46 %) – unilateral occlusion of the iliac-femoral zone.
Two groups of patients were identified in the study: group I – 81 patients with recurrence of chronic arterial insufficiency: in 32 (39.63 %) – chronic arterial insufficiency IIB stage, in 49 (60.49 %) – chronic arterial insufficiency III stage; group II – 47 patients: 38 (80.85 %) were diagnosed late thrombosis of the aorto/iliac-bifemoral alloprosthesis and 9 (19.17 %) with thrombosis of the iliac-femoral segment of the contralateral lower extremity.
In patients, the status of coagulation and fibrinolytic systems was determined.
Results and Discussion. As a result of studies of the hemocoagulation system of patients with recurrence of chronic arterial ischemia and postoperative alloprosthesis branch thrombosis and thrombosis of the iliac-femoral segment of the contralateral lower extremity, it is possible to state that the coagualation system is active before operation. Surgery is accompanied by increased coagulation and aggregation properties of the blood system. Hypercoagulation at the intraoperative stage of surgery is formed due to the increasing blood content of the fibrin-thrombin fraction of the hemocoagulative cascade, which contributes to the formation of fibrinogen.
Based on the results of the study of the hemocoagulation system, schemes of thromboprophylaxis in patients with atherosclerotic lesions of the aorta and main arteries of the lower extremities during reconstructive operations were proposed.
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