Surgery on extracranial arteries in patients with atherosclerotic occlusion of the aorto-iliac-femoral arterial bed in conditions of chronic ischemia
DOI:
https://doi.org/10.11603/2414-4533.2023.4.14343Keywords:
extracranial arteries, atherosclerosis, occlusionAbstract
The aim of the work: to identify the causes of the development of ischemic disorders of the brain after surgical correction of blood flow along the ICA in patients with atherosclerotic stenosis/occlusion of the ICA with atherosclerotic occlusion aorto-iliac-femoral basin in conditions of chronic ischemia of the lower extremities.
Materials and Methods. 119 patients with atherosclerotic occlusion of the aorto-iliac-femoral basin with CAI IIb-IV stages (according to the Rutherfordclassification). Patients are divided into two groups: group I – 72 patients from the CAI IIb–IV stages with high in 58 observations and very high in 14 cases by the degree of risk of developing postoperative complications, group II – 47 patients with CAI of the III–IV stages with high in 7 observations and very high in 40 observation of the degree of risk of developing postoperative complications. group II includes patients with atherosclerotic occlusion of the aorto-iliac femoral segment and a high risk of development reperfusion-reoxygenation syndrome in the early postoperative period. In the period of preparation for revascularization of atherosclerotic occlusion of the aorto-iliac-femoral zone, a study of the state of the circle of Willis was carried out. Among 93 patients with atherosclerotic lesions of extracranial arteries 62 (64.41 %) people had a closed circle of Willis, and 31 (33.33 %) observations – an open Willis circle. Among patients, group I is open Circle of Willis was found in 15 observations (48.39 %), and among patients in
group II – in 16 (51.61 %) observations.
Results and Discussion. 32 patients underwent surgical correction of blood flow in the ICA, of which 18 patients were in the group I and 14 in group II. II stage of violation of cerebral blood flow was diagnosed in 18 observations – transient ischemic attack, in 7 patients – III stage of violation of cerebral blood flow, and in 3 people – V stage violation of cerebral blood flow. 32 surgical interventions on the ICA were performed: in 32 observations – carotid endarterectomy, in 6 and 4 cases, respectively, reversion and eversion restoration of blood flow along the ICA. In 3 observations endovascular stenting of the stenotic/occluded ICA was performed.
References
Gardubey, E.Yu., Polinchuk, І.С., & Sidorko, Yu.V. (2014). Dyferentsialnyi pidkhid do likuvannia patsiientiv z aterosklerotychnym okliuziino-stenotychnym urazhenniam aorto- klubovoho sehmenta [Differential approach to the treatment of patients with atherosclerotic occlusive-stenotic lesions of the aorto-iliac segment]. Sertse i sudyny – Heart and Vessels, 1, 119-123 [in Ukrainian].
Walker, C.M., Bunch, F.T., Cavros, N.G., & Dippel, E.J. (2015). Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clinical Interventions in Aging, 1147-1153.
Nikulnikov, P.I., & Ratushnyuk, A.V. (2013). Konservativnoye lecheniye patsiyentov po povodu kriticheskoy ishemii nizhnikh konechnostey. Klíníchna khírurgíya, 7, 76-77 [in Russian].
Trutyak, T.I., Kobza, I.I., Kobza, R.I., Melen, A.P., Yarka, A.O. (2013). Vyznachennya tyazhkosti perebihu tserebralnoi hiperperfuzii [Determining the severity of cerebral hyperperfusion]. Khirurhiia Ukrainy – Surgery of Ukraine, 4 (48), 282-287 [in Ukrainian].
Huibers, A.E., Westerink, J., de Vries, E.E., Hoskam, A., den Ruijter, H.M., Moll, F.L., & de Borst, G.J. (2018). Editor’s choice–cerebral hyperperfusion syndrome after carotid artery stenting: a systematic review and meta-analysis. European Journal of Vascular and Endovascular Surgery, 56 (3), 322-333.
Kobza, I.I., Melen, A.P., Kobza, T.I., Trutyak, R.I., Lebedyeva, S.A., & Orel, Yu.H. (2012). Znachennia aterosklerotychnoho urazhennia ipsilateralnoi zovnishnoi sonnoi arterii v patsiientiv z okliuziieiu vnutrishnoi sonnoi arterii [The value of atherosclerotic lesions of the ipsilateral external carotid artery in patients with internal carotid artery occlusion]. Naukovyi visnyk Uzhhorodskoho universytetu – Scientific Herald of Uzhhorod University 2, 49-52 [in Ukrainian].
Brott, T.G., Halperin, J.L., Abbara, S., Bacharach, J.M., Barr, J.D., & Bush, R. L. (2011). Guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Circulation, 124(4), 489-532.
Liapis, C. D., Bell, P. R. F., Mikhailidis, D., Sivenius, J., Nicolaides, A., e Fernandes, J. F., ... & ESVS Guidelines Collaborators. (2009). ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. European Journal of Vascular and Endovascular Surgery, 37(4), 1-19.
Brantley, H.P., Kiessling, J.L., Milteer Jr, H.B., & Mendelsohn, F.O. (2009). Hyperperfusion syndrome following carotid artery stenting: the largest single-operator series to date. The Journal of Invasive Cardiology, 21(1), 27-30.
Hamamura, T., Morioka, T., Sayama, T., Mukae, N., Arakawa, S., Maeda, H., & Sasaki, T. (2010). Cerebral hyperperfusion syndrome associated with non-convulsive status epilepticus following superficial temporal artery-middle cerebral artery anastomosis – case report. Neurologia Medico-chirurgica, 50 (12), 1099-1104.
Forbes, T. (Ed.). (2012). Angioplasty, Various Techniques and Challenges in Treatment of Congenital and Acquired Vascular Stenoses. BoD–Books on Demand.
Haug, M. (2007). Hyperperfusion syndrome following carotid revascularization--a subject for the family doctor. Zentralblatt fur Chirurgie, 132(3), 187-192.
Venher, I. K., & Faryna, I. V. (2022). Predyktory reperfuziyno-reoksyhenatsiynoho syndromu v patsiyentiv z aterosklerotychnoyu oklyuziyeyu aorto-stehnovoho baseynu. Shpytalʹna khirurhiya. Zhurnal imeni L. YA. Kovalʹchuka, 4, 62–68 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 І. К. ВЕНГЕР, І. В. ФАРИНА
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:
- 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.
- 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.
- 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)
