The remote complications of revascularization in patients with combined atherosclerotic affection of extractional arteries and aorto-iliac-femoral-popliteal arterial bed
DOI:
https://doi.org/10.11603/2414-4533.2019.1.9910Keywords:
obliteration atherosclerosis, revascularization, complications of reconstructive interventionsAbstract
The aim of the work: to establish the types and frequency of remote postoperative complications, the development of which could be prevented by applying the ways and methods of surgical intervention in the reconstruction of the aorto/iliac-femoral-popliteal arterial bed.
Materials and Methods. The remote results of surgical treatment of 491 patients during 2006–2017 were studied. 341 (69.4 %) patients with atherosclerotic occlusion of the aortic-femoral area were subjected to surgical intervention, of whom 248 patients had a violation of the flow in the femoral-popliteal segment. Operative treatment was performed in 150 (30.6 %) patients with occlusive-stenotic affection of iliac-femoral segment, of which 94 had violations of the blood flow along the hip-popliteal arterial line. In 92 (18.7%) patients, hemodynamically significant stenosis of extracranial arteries was diagnosed, of whom 75 patients underwent surgical intervention on the neck vessels in conditions of surgical treatment of atherosclerotic lesion of the aorto/iliac-femoral-popliteal arterial bed.
Results and Discussion. After 491 reconstructive surgical interventions on the aorto/iliac-femoral-popliteal arterial line in the remote postoperative period, 139 (28.3 %) of late complications were diagnosed. Among them, late thrombosis of the aorto/iliac-femoral alloprosthesis and late thrombosis of iliac-femoral segment of the contralateral lower limb developed in 42 (30.9 %) patients; false aneurysms of the distal and proximal anastomosis of the aorto/iliac-femoral alloshunt in 11 (7.9 %) were diagnosed in 78 (56.1%) patients; the increasing of chronic lower limb ischemia was established (ChAI IIIA-Bstage according to the classification of Fontaine R. taking into account the criteria of the European Working Group (1992)), the late infectious complications in the form of a fist in the region of distal anastomosis were diagnosed in 8 (5.8 %) patients. Development of such late complications as thrombosis of the iliac-femoral segment (6 observations) of the contralateral lower limb; late thrombosis of one of the branches of aorta-bifemoral aloshunt (5 observations) as a result of blocking by the occlusive process of anastomoses of the superficial femoral artery and the profound femoral artery with the descending artery of the knee, popliteal artery and tibial arteries; the false aneurysm of proximal anastomosis (2 observations) of the aorto-femoral aloshunt, as a result of the formation of anastomosis within the limits of limited blood supply to the edges of the medial aortotomic incision, can be prevented by applying ways and methods of surgical intervention in the composition of the aorto/iliac-bifemoral aloshunting.
In the presence of hemodynamically significant atherosclerotic stenosis of extracranial arteries in patients with atherosclerotic occlusion of the aorto/iliac-femoral-popliteal arterial line, surgical intervention on the vessels of the neck should be performed before or simultaneously with the surgical intervention on the aorta/iliac-femoral-popliteal zone.
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