POSTOPERATIVE COMPLICATIONS OF ENDOVASCULAR REVASCULARIZATION OF MULTILEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED – SURGICAL TREATMENT
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i2.13132Keywords:
endovascular revascularization, stenotic-occlusive lesionsAbstract
SUMMARY. One of the ways to solve the problem of surgical treatment of patients with multilevel lesions of the arterial bed of the lower extremities may be the use of endovascular and hybrid revascularization technology. A number of authors draw attention to the fact that endovascular revascularization technologies contribute to 6–32 % of observations of thrombosis of the reconstruction segment, lack of revascularization effect, restenosis of the surgical segment. In addition, there is no information on surgical treatment of postoperative complications, especially in patients after endovascular revascularization of multilevel stenotic-occlusive lesions of the femoral-distal artery. Therefore, the treatment of patients with multilevel atherosclerotic lesions of the arterial bed of the lower extremities remains a rather complex and in many cases unresolved problem.
The aim – to improve the results of endovascular revascularization of multilevel stenotic-occlusive lesions of the femoral-distal arterial bed by identifying complications of the postoperative period and their surgical correction.
Material and Methods. 135 patients were monitored. Of these, 74 were hybrid endovascular revascularization, 61 – endovascular revascularization of multilevel stenotic-occlusive lesions of the femoral-distal arterial bed.
Endovascular angioplasty of the femoral segment was performed with balloon catheters Pan Medical (PEKICO), OPTA PRO (Cordis) – 50 observations. After balloon angioplasty, self-opening stents Smart ControL (Cordis) were used in 5 cases, Carbostent (Flype) in 4 cases, and Vascular stent (BARD) in 7 cases. During the endovascular stage of hybrid surgery, intraluminal angioplasty of the tibial arteries was performed, and in 14 – subintimal angioplasty and subsequent stenting. In all observations, long cylinders (80–150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific), and stents CompleteSE (Medtronic), Smart (Cordis) were used. 122 endovascular angioplasties of the tibial arteries were performed. Of these, angioplasty of only one of the tibial arteries was performed in 26 (35.13 %) cases, and two vessels at the same time in 48 (64.87 %) cases.
Results. The direct results of endovascular revascularization of the multilevel stenotic-occlusive process of the femoral-distal arterial bed in 61 patients were observed during the 30-day postoperative period. In 5 (8.20 %) patients on the 3rd and 5th day of the early postoperative period, thrombosis of the reconstruction segment was diagnosed: in 4 of them – thrombosis of the popliteal-tibial segment, and in one – thrombosis of the femoral-popliteal segment. Reconstruction segment thrombosis was detected in 4 patients in whom endovascular angioplasty of only one of the stenotically-occluded tibial arteries was performed during endovascular revascularization of the femoral-distal arterial bed. Thus, on the 30th day of the early postoperative period in 59 (93.44 %) patients the patency of the reconstruction segment was preserved and the lower extremity was preserved.
The results of hybrid revascularizing surgical interventions in 71 patients with stenotic-occlusive lesion of the infranguinal arterial bed in the conditions of atherosclerotic lesion of the tibial arteries were followed during 36 months of the postoperative period. In 6 (8.45 %) patients in the first 3 months of the remote postoperative period, thrombosis of the patellar segment was diagnosed. Thus, it was found that at 36 months of observation after hybrid revascularization of the femoral-distal arterial bed, the preservation of the lower extremity was (65) 91.55 %, and the preserved patency of the reconstruction segment – in (63) 88.73 % of observations.
Conclusion. The formation of a functional suitable outflow path in endovascular revascularization of multilevel stenotic-occlusive lesion of the femoral-distal artery by endovascular angioplasty of two tibial arteries contributes to reducing the incidence of postoperative thrombosis of the revascularization segment and preservation, preservation, revascularization, preservation.
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