A.A. Irnazarov
Tashkent Medical Academy
U.A. Asrorov
Tashkent Medical Academy
Kh.A. Avlonazarov
Tashkent Medical Academy
I.R. Beknazarov
Tashkent Medical Academy
Abstract
Relevance. Hybrid surgery is a modern approach to the treatment of atherosclerotic vascular lesions of the lower extremities. They combine traditional "open" operations and endovascular interventions, which makes them the optimal treatment method in terms of reducing the number of complications after surgery.
The aim of study
To evaluate the effectiveness of hybrid surgical interventions in patients with multi-storey lesions in atherosclerosis of the vessels of the lower extremities.
Material and methods
The study included 52 patients with atherosclerotic lesions of the arteries of the lower extremities in the stage of critical ischemia. The patients underwent "hybrid" operations: open reconstructive surgery on the femoral-popliteal-tibial segment followed by X-ray endovascular angioplasty of the leg arteries. The results of surgical treatment in the short term were assessed up to 30 days after the operation, and long-term results - within 2 years after the operation.
Results
46 (88.4%) of 52 patients showed clinical success on the Rutherford scale (+2 and +3). In the postoperative period of patients, complications such as bleeding (5.7%), thrombosis of the reconstruction zone (5.7%), healing by secondary intention (3.8%) and hematoma (1.9%) were observed. In general, the proportion of complications was low. Observations of patients 1 year later after surgery showed that 67.3% of them retained a limb and had no symptoms of critical ischemia of the lower limbs. Relapse was observed in 26.5% of patients, and severe course and the need for amputation was recorded in 6.2% of cases.
Conclusion
A high level of patency (more than 90%) was revealed in patients undergoing surgical treatment by means of hybrid interventions. Nevertheless, in the long-term period there is a rather noticeable percentage of relapses (26.5%), which requires the development of an optimal algorithm for managing patients.
Keywords:
atherosclerosis; atherosclerotic vascular lesions of the lower extremities; hybrid surgery.
References
1. Bokeriya LA, Abdulgasanov RA, Temrezov MB. Modern principles of treatment for chronic critical ischemia of lower extremities. Clinical physiology of blood circulation. 2011;2:12–17.
2. National guidelines on the management of patients with arterial diseases of the lower extremities. Russian consensus document. [Angiology and Vascular Surgery. 2013;19(suppl.):1–67. In Russian.
3. Bokeriya LA, Temrezov MB, Kovalenko VI et al. Surgical treatment of patients with primary critical ischemia of the lower extremities. Annals of Surgery. 2010;1:16–19. In Russian.
4. Nelson PR, Powell RJ, Schermerhorn ML et al. Early results of external iliac artery stenting combined with common femoral artery endarterectomy. J Vasc Surg. 2002;35(6):1107–1113.
5. Kazakov YI, Lukin IB, Kazakov AY et al. Choice of vascular reconstruction method in critical lower limb ischemia. Angiology and Vascular Surgery. 2015;21(2):152–158. In Russian.
6. Nishibe T, Kondo Y, Dardik A et al. Hybrid surgical and endovascular therapy in multifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino). 2009;50(4):493–499.
7. Chernyavskiy MA, Artyushin BS, Chernov AV et al. A clinical case of hybrid treatment of a patient with multilevel arterial occlusive disease in lower limb arteries. Circulatory pathology and cardiac surgery. 2018;22(4):103–110. In Russian.
8. Antoniou GA, Sfyroeras GS, Karathanos C et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg. 2009;38(5):616–622.
9. Matsagkas M, Kouvelos G, Arnaoutoglou E et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg. 2011;25(8):1063–1069.
10. Schanzer A, Owens CD, Conte MS et al. Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts. J Vasc Surg. 2007;45(4):740–743.
11. Ballotta E, Gruppo M, Mazzalai F et al. Common femoral artery endarterectomy for occlusive disease: an 8-year single-center prospective study. Surgery. 2010;147(2):268–274.
12. Dake MD, Ansel GM, Jaff MR et al., Zilver PTX Investigators. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv. 2011;4(5):495–504.
13. Gray BH, Grant AA, Kalbaugh CA et al. The impact of isolated tibial disease on outcomes in the critical limb ischemic population. Ann Vasc Surg. 2010;24(3):349–359.
