PREOPERATIVE PREPARATION OF PATIENTS WITH OCCLUSIVE PROCESS OF THE AORTIC/FEMORAL-POPLITEAL BASIN IN CHRONIC CRITICAL LIMB ISCHEMIA AND RISK OF DEVELOPING REPERFUSION-REOXYGENATION SYNDROME
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i4.15034Keywords:
reperfusion-reoxygenation syndrome, atherosclerosis, occlusion, chronic critical limb ischemiaAbstract
SUMMARY. A technically successful operation does not guarantee the restoration of peripheral blood flow and preservation of the lower limb, which is most often encountered during revascularization of patients with atherosclerotic occlusion of the aortic/femoral-popliteal basin in the context of chronic critical limb ischemia and a high risk of developing reperfusion-reoxygenation syndrome.
The aim – to improve reconstruction outcomes in patients with atherosclerotic occlusion of the aortic/femoral-popliteal basin in the context of chronic critical limb ischemia and the risk of developing reperfusion-reoxygenation syndrome.
Material and Methods. The article discusses the results of reconstructive surgeries on the main arterial pathways of the lower limbs in patients with atherosclerotic occlusion of the aorto-bifemoral arterial system under conditions of chronic critical limb ischemia (CCLI) and the risk of developing reperfusion-reoxygenation syndrome (RRS). The study involved 104 patients, divided into two groups based on the degree of risk for complications.
Results. The study included 104 patients, divided into two groups based on the degree of risk for complications. The analysis showed that postoperative complications occurred in a significant portion of patients: during the period from 2014 to 2018, complications were diagnosed in 78.2 % of patients, while from 2019 to 2023, their frequency decreased to 38.9 %. This indicates the effectiveness of improved preoperative preparation approaches, which included epidural anaesthesia, hyperbaric oxygenation, administration of hyperosmotic dextrin, alprostadil-based medications, and other measures. An important aspect is the development of reperfusion-reoxygenation syndrome, which occurred in 23.3 % of patients in 2014–2018 and in 15.4 % in 2019–2023. The pathogenesis of RRS involves the activation of inflammatory reactions, the formation of free radicals, and the deterioration of microcirculation, leading to serious postoperative complications, including lower limb oedema and renal failure.
Conclusions. The implementation of a comprehensive pathogenetically grounded preoperative preparation demonstrated a positive effect on reducing the frequency of postoperative complications in the early postoperative period in patients with aorto/iliac-femoral occlusion and chronic critical limb ischemia (CCLI) at a risk of complications (RRS) by 1.8 times.
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