THROMBOPROPHYLAXIS IN REVASCULARIZING OPERATIONS IN PATIENTS WITH ATHEROSCLEROTIC DEFEAT OF MAIN ARTERIES OF LOWER EXTREMITIES UNDER CONDITIONS OF CHRONIC CRITICAL ISCHEMIA

Abstract

INTRODUCTION. Reconstructive methods of treatment make it possible to preserve the lower limbs during critical ischemia of their tissues in 45–55 % of patients. Despite the use of various surgical technologies in the treatment of obliterating diseases of the aorta and peripheral arteries of the lower extremities, today the frequency of both early and late complications of reconstructive interventions is quite significant, in particular, thrombosis of the reconstruction segment is found in 42–59 % of observations. Thromboprophylaxis using industry protocols, the use of an alopecia with impregnation of silver ions do not solve the problem.

The aim of the study – to learn the hemostatic system in revascularizing operations in patients with atherosclerotic lesions of the main arteries of the lower extremities in chronic critical ischemia, and to develop appropriate thromboprophylaxis.

Material and Methods. 106 patients were examined, 18 of them were diagnosed with aneurysm of the infrarenal part of the aorta, 39 – atherosclerotic occlusion of the aorto-iliac segment, 13 of them – segmental occlusion of the femoral-distal arterial bed, 12 – iliac-femoral atherosclerotic occlusion, 27 – stenotic-occlusal atherosclerotic lesion of the femoral-distal arterial bed of the lower extremities. All patients with atherosclerotic lesions of the arterial system of the lower extremities were diagnosed with chronic arterial ischemia of stage IIIA – IIIB (according to A. V. Pokrovsky).

Results and Discussion. During reconstructive operations in patients with atherosclerotic lesions of the main arteries of the lower extremities in chronic critical ischemia, the thromboprophylaxis method should include the introduction of unfractionated heparin, which exhibits a dominant effect on the second factor (thrombin – fibrinogen) of the hemocoagulation cascade immediately interventions. It is the combination of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) that makes it possible to simultaneously affect various factors of the coagulation system and reduce the risk of thrombosis in the vascular system. Patients with a high risk of developing reperfusion complications with the goal of thromboprophylaxis should use therapeutic doses of anticoagulants.

Conclusion. In connection with the preservation of the hypercoagulative state of the blood coagulation system during the first day, the administration of UFH at half the initial dose of the drug should be continued for the next 7–9 days. From the second day of the early postoperative period, thromboprophylaxis of UFH can be replaced by LMWH, which exhibit a dominant effect on the Ha factor of the hemocoagulation cascade.