Comparative analysis of the surgical treatment results in patients, suffering obliterating atherosclerosis of the lower extremities arteries with multi–level occlusion–stenotic affection on background of critical ischemia
Objective. To improve the results of surgical treatment in patients, suffering obliterating atherosclerosis of the lower extremities (LE) arteries with a multi-level occlusive affection, occurring on background of critical ischemia (CІ).
Маterials and methods. The results of surgical treatment of 93 patients, suffering a multi-level occlusive affection of the LE arteries, occurring on background of CІ, performed with obligatory ultradistal restoration of the blood circulation, were analyzed. The main group consisted of 47 (51%) patients, to whom a hemi-open endarterectomy from popliteal artery was performed together with a popliteo-foot autovenous shunting, and a comparison group, consisting of 46 (49%) patients, in whom endovascular angioplasty of popliteo-tibial segment was done.
Results. Comparative analysis of the surgical interventions performed have witnessed, that while presence of the Types С and D occlusive-stenotic affections in accordance to classification of Тransatlantic Consensus (TASC II), a choice for open reconstructions must be prioritized, and in a Type В and in some of a Type С observations – a primary angioplasty. When the Type С peculiarities of occlusive affection were revealed, a differentiated approach must be applied while formulating indications for the operation. Results of the interventions performed were followed-up in late period (up to 24 mo).
Conclusion. While diagnosis of a Type D occlusion of the shin segment a priority must be referred to operation of a popliteo-foot shunting, and in a Type С – to primary angioplasty, only in presence of diffuse stenotic process without «free» аrterial segment of the foot. Administration of vasostenone promotes effective reduction of peripheral arterial resistance in patients after performance of open surgical intervention as well as in those after angioplasty operation.
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