INNOVATIVE TECHNOLOGIES IN THE SURGICAL TREATMENT OF OCCLUSIVE-STENOTIC LESIONS OF THE ARTERIES OF THE INFRARENAL SECTION OF THE AORTA
DOI:
https://doi.org/10.11603/2414-4533.2024.4.15069Keywords:
risk factors, atherosclerosis of the arteries of the lower extremities, occlusion, stenosis, thrombosis, limb ischemia, ischemic heart disease, diabetes mellitus, arterial shunting, vascular anastomoses, arterial prosthetics, endovascular balloon angioplasty, arterial stenting, hybrid operationAbstract
The aim of the work: to increase the effectiveness of surgical treatment of occlusive-stenotic lesions of the main arteries of the infrarenal section of the aorta in patients with atherosclerosis, through a differentiated approach to the use of innovative technologies of open, endovascular and hybrid surgical interventions.
Materials and Methods. The study included 420 patients with occlusive-stenotic lesions of the main arteries of the infrarenal aorta. Patients are divided into subgroups according to the segments of atherosclerotic lesion: aorto-joint – 20 (4.76 %), joint-femoral – 45 (10.72 %), femoral-popliteal – 166 (39.52 %), popliteal-tibial – 124 (29.53 %), tibial-foot – 65 (15.47 %). Depending on the nature of the surgical intervention, they are divided into: open – 98 (23.33 %), endovascular – 243 (57.86 %), hybrid – 79 (18.81%) operations.
Results. The analysis of the early results of surgical interventions showed a probable decrease in the duration of treatment of patients in a hospital from (5.2±0.7) to (1.3±0.6) bed days, a decrease in re-hospitalization within 12 months by 12.5 %, a decrease in the number of postoperative complications from 10.5 to 4.9 %, reoperations from 9.72 to 3.06 %, amputations from 5.4 to 1.84 %, and mortality from 3.89 to 1.84 %. In the distant postoperative period (up to 5 years), it was possible to increase the effectiveness of treatment of patients with OSUMA, as evidenced by a decrease in the number of postoperative complications from 7.87% to 4.39%, repeated operations – from 7.87 to 4.39 %, amputations – from 3.63 to 2.19 % and mortality – from 3.03 to 1.09 %.
Conclusions. The use of innovative technologies in open, endovascular and hybrid surgical interventions with the implementation of a treatment algorithm based on individual anatomical and hemodynamic characteristics, improvement of surgical methods, use of 2D-perfusion in the assessment of peripheral blood flow, use of implants treated with recipient serum before implantation, and ultrasound monitoring during surgical interventions made it possible to improve the results of treatment of patients with occlusive-stenotic lesions of the main arteries of the infrarenal aorta.
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