Risk criteria for the development of complications in patients with multilevel stenotic-occlusive lesions of the femoral-distal arterial bed
DOI:
https://doi.org/10.11603/2414-4533.2023.1.13544Keywords:
stenotic-occlusive lesion, risk of complications, prognosisAbstract
The aim of the study – to establish the level of risk of developing complications in patients with multilevel stenotic-occlusive lesions of the infrainguinal arterial bed to determine the volume of preoperative preparation, the choice of the method of anesthetic support and the method of surgical treatment of the pathology.
Materials and Methods. 164 patients were included in the study. The criteria for the inclusion of patients (164 people) in the study and endovascular methods of revascularization were single or multiple atherosclerotic stenotic-occlusive lesions of the femoral-popliteal arterial bed with stenotic-occlusive lesions of the tibial arteries. Among patients who were scheduled to undergo two-level endovascular angioplasty, hemodynamically insignificant stenosis of the iliac segment, in the symptomatic (10) and in the contralateral lower limb (6), was found in 21.92 % of observations [9].
In patients who were planned to undergo a hybrid method of revascularization, in 20 (21.98 %) observations, stenosis>71 %/ occlusion of the terminal segment of femoral artery of the symptomatic lower limb, which extended to the initial segment of the femoral artery, was revealed.
All patients who were scheduled for two-level endovascular angioplasty of the arterial bed of the lower extremity had stenosis > 60 %/superficial femoral artery occlusion of the symptomatic lower extremity [3,10].
In this case, in which we propose to perform a hybrid method of revascularization, in 51 (56.04 %) observations, stenosis > 60 %/occlusion of superficial femoral artery was diagnosed and in 25 (26.80 %) cases of stenosis >60 %/occlusion of superficial femoral artery, which extended to the symptom superficial femoral artery lower extremity.
In both groups, among the inclusion criteria of the need for two-level endovascular angioplasty and hybrid methods of revascularization of the multi-level stenotic-occlusive process of the femoral-distal arterial bed of the lower extremity should be АВI ≤ 0.53 and sPO2 ≤ 40.0 mmHg.
Results and Discussion. To establish the level of risk of developing complications when using endovascular methods of revascularization in patients with multilevel atherosclerotic stenotic-occlusive lesions of the femoral-distal arterial bed, the technique of predicting the risk of developing complications was used.
A number of scales and classifications are proposed for determining the frequency of complications of surgical treatment of patients. At the same time, a significant number of them are aimed at a specific pathology or a set of similar diseases to determine the risk of their complications during surgical intervention. Others are aimed at determining complications and the possibility of their prevention when using some methods and methods of preparation for surgical intervention, its implementation, the use of a number of surgical interventions and their modifications, increasing the performance of operative interventions. None of them has a comprehensive approach to determining the risk of developing complications of surgical treatment [12].
The scale of risk stratification of the development of complications of operative treatment of the main arteries of the lower extremities takes into account the multifactorial nature of the clinical and anamnestic and laboratory and instrumental studies of each patient. At the same time, a combination of factors that characterize the functional state of the patient’s organs and systems, their mutual influence and the formation of a collective response to operative aggression are taken into account.
When analyzing the results of determining the level of risk of developing complications of revascularization of the arterial bed in patients with multilevel atherosclerotic stenotic-occlusive process of the femoral-distal arterial bed, it was established that in 69.51 % of observations a moderate level of risk of developing complications was established, in 26.84 % of cases a high level of the second group in terms of the number of patients included patients with a high risk of developing complications (24.66–28.57 %).
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