Intraoperative state of the hemocoagulation system in patients with open and endovascular revacularization of infraingual arterial segment in the presence of stenotic-occlusive process of tibial arteries

Authors

  • S. Ya. Kostiv I. Horbachevsky Ternopil National Medical University
  • B. P. Selskyi I. Horbachevsky Ternopil National Medical University
  • M. P. Orlov I. Horbachevsky Ternopil National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2022.1.12913

Keywords:

blood coagulation and aggregation system, revascularization, thrombosis

Abstract

The aim of the work: to prevent thrombotic complications through vascular revascularization of the lower extremity using a pathogene­tically reasonable system of postoperative thromboprophylaxis.

Materials and Methods. This study included 97 patients with atherosclerotic stenotic-occlusive process of the infrainguinal artery in terms of stenotic-occlusive lesions of the tibial arteries. In order to study the state of the hemocoagulation system on patients, methods were used to study the indicators of coagulation, fibrinolytic and aggregation systems.

Results and Discussion. The formation of hypercoagulable disorders in patients who used endovascular methods of revascularization of the arterial segment is more intense than in patients who performed open vascular revascularization methods. Hypercoagulation of blood at the intraoperative stage of revascularization occurs primarily due to the activity of factor II a of the hemocoagulation cascade. Given the above circumstances, already at the stage of completion of surgery for thromboprophylaxis should be prescribed – non-fractionated heparin (NFH). At the same time for the prevention of thromboembolic complications should be prescribed double anti-thrombocyte therapy: clopidogrel, acetylsalicylic acid.

Hypercoagulant ability of the blood system, which occurs after arterial reconstructive interventions occurs against the background of low activity of the fibrinolytic blood system, but with a gradual increase in the activity of the aggregation capacity of the blood. The formation of hypercoagulable disorders at the intraoperative stage of surgery in patients with endovascular methods of arterial reconstructions is more intense than in patients with open methods of arterial revascularization. Given these circumstances, already at the stage of completion of surgery for thromboprophylaxis should be prescribed an anticoagulant that has a targeted effect on factor IIa of the hemocoagulant cascade with simultaneous prevention of thromboembolic complications – double anti-thrombocyte therapy.

References

Špillerová, K., Settembre, N., Biancari, F., Albäck, A., & Venermo, M. (2017). Angiosome targeted PTA is more important in endovascular revascularisation than in surgical revascularisation: Analysis of 545 patients with ischaemic tissue lesions. European Journal of Vascular and Endovascular Surgery, 53 (4), 567-575. DOI: 10.1016/j.ejvs.2017.01.008

Tan, H., Zhang, L., Guo, Q., Yao, Y., Sun, S., & Wang, T. (2013). “One-stop hybrid procedure” in the treatment of vascular injury of lower extremity. Indian Journal of Surgery, 77 (1), 75-78. DOI: 10.1007/s12262-013-0897-1

Didenko, S. (2018). Paths of collateral blood circulation with stenotic-occlusive lesions of the femoro-popliteal and cruro-pedal arterial segments in patients with ischemic form of diabetic foot syndrome. Acta Medica Leopoliensia, 24 (2), 34-38. DOI: 10.25040/aml2018.02.034

Pshenichny, V.N., Shtutin, A.A., Ivanenko, A.A., Voropaev, V.V., Kovalchuk, O.N., & Gaevoi, V.L. (2012). Effektivnost dvukhurovnevykh infraingvinalnykh rekonstruktsiy v lechenii khronicheskoy kriticheskoy ishemii nizhnikh konechnostey [Efficacy of two-level infrainguinal reconstructions in treatment of chronic critical lower limb ischa]. Angiologiya i sosudistaya khi­rurgiya – Angiology and Vascular Surgery, 18 (3), 132-137.

Rusyn, V., Popovych, Y., Korsak, V., & Rusyn, V. (2014). The place of hybrid surgery in treatment of critical lower limb ischemia. Novosti Khirurgii, 22 (2), 244-251. DOI: 10.18484/2305-0047.2014.2.244

Matsagkas, M., Kouvelos, G., Arnaoutoglou, E., Papa, N., Labropoulos, N., & Tassiopoulos, A. (2011). Hybrid procedures for patients with critical limb ischemia and Severe Common Femoral Artery Atherosclerosis. Annals of Vascular Surgery, 25 (8), 1063-1069. DOI: 10.1016/j.avsg.2011.07.010

Hicks, C., Najafian, A., Farber, A., Menard, M., Malas, M., Black, J., & Abularrage, C. (2016). Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia. Vascular Medicine, 22 (1), 28-34. DOI: 10.1177/1358863x16676901

Norgren, L., Hiatt, W., Dormandy, J., Nehler, M., Harris, K., & Fowkes, F. (2007). Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur. J. Endovasc. Surg., 45 (1), S1-75. DOI: 10.1016/j.ejvs.2006.09.024.

Iida, O., Takahara, M., Soga, Y., Yamauchi, Y., Hirano, K., & Tazaki, J. et al. (2013). Worse limb prognosis for indirect versus direct endovascular revascularization only in patients with critical limb ischemia complicated with wound infection and diabetes mellitus. European Journal of Vascular and Endovascular Surgery, 46 (5), 575-582. DOI: 10.1016/j.ejvs.2013.08.002

Venher, I., Kostiv, S., Zarudna, O., & Kostiv, O. (2017). Shli­a­­khy poperedzhennnia pisliaoperatsiinykh venoznykh tromboembolichnykh uskladnen u patsiientiv iz planovoiu khirurhichnoiu patolohiieiu [The ways of prevention of post-operative venous thromboembolic complications in patients with planned surgical pathology]. Shpytalna khirurhiia. Zhurnal im. L. Ya. Kovalchuka – Hospital Surgery. Journal named after L. Ya. Jovalchuk, (3). DOI: 10.11603/2414-4533.2017.3.8122

Rosenberg, A., Zumberg, M., Taylor, L., LeClaire, A., & Harris, N. (2010). The use of anti-xa assay to monitor intravenous unfractionated heparin therapy. Journal of Pharmacy Practice, 23 (3), 210-216. DOI: 10.1177/0897190010362172

Downloads

Published

2022-05-20

How to Cite

Kostiv, S. Y., Selskyi, B. P., & Orlov, M. P. (2022). Intraoperative state of the hemocoagulation system in patients with open and endovascular revacularization of infraingual arterial segment in the presence of stenotic-occlusive process of tibial arteries. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (1), 19–25. https://doi.org/10.11603/2414-4533.2022.1.12913

Issue

No. 1 (2022)

Section

ORIGINAL INVESTIGATIONS

License

Copyright (c) 2022 Hospital Surgery. Journal named by L.Ya. Kovalchuk

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  
  2. Лицензия Creative Commons
  3. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  4. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)