Stages in surgical tactics in multi-floor оcclusive-stenotic affections of abdominal aorta and arteries of the lower extremities in patients, suffering obliterating atherosclerosis
Objective. To improve the results of surgical treatment in patients with multi-floor occlusive-stenotic affections of abdominal aorta and arteries of the lower extremities on background of critical ischemia.
Маterials and methods. The results of surgical treatment were studied in 135 patients with multi-level occlusive affections and critical ischemia of the lower extremities. There were 68 (50.4%) patients in the main group, in whom a bifurcational aorto-femoral alloshunting, combined with femoro-popliteal shunting, using criterion - іntraoperative determination of value of a retrograde blood circulation along a. femoris profunda (AFP). In a comparison group 67 (49.6%) patients were included, in whom a standard volume of reconstructive operations was applied.
Results. Аnalysis of results of the operative interventions performed have witnessed, that application, besides a standard diagnostic methods, of ultrasound duplex scanning (USDS), аrteriography, multispiral computed tomography (МSСТ), іntraoperative debitometry gave a possibility to objectivize a retrograde blood circulation state and timely correction of volume and a staged character of surgical intervention. Because of that, it was possible to dilate the indications for performance of simultaneous multi-level reconstruction of abdominal aorta and the lower extremities arteries without enhancement of rate of postoperative morbidity and cardiological complications.
Conclusion. Application of elaborated hemodynamical criterion for determination of value of retrograde blood flow along AFP 80 ml/min have permitted to optimize a surgical tactics and to improve the surgical treatment results significantly. Administration of «Valargin» preparation in a 3000 mg/day dose during 20 days have improved the аngioprotection in immediate postoperative period.
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