Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.
Background. The restoration of arterial blood flow does not guarantee the restoration of adequate oxygenation of the tissues of the lower extremity after chronic ischemia.Purpose. To study the patterns of changes in oxygen transport function (OTF) and blood gas transmitters in patients who underwent loop endaterectomy (LEAE) from the superficial femoral artery (SFA).Material and methods. We examined 103 patients with occlusion of SFA, which was eliminated by the method of LEAE. The OTF indices, the content of nitrogen monoxide and hydrogen sulfide were determined before the operation as well as on the third and eighth day of the postoperative period.Results. The obtained data suggested an increase in the saturation of venous blood with oxygen and concentration of gas transmitters in сhronic ischemia and after LEAE.Conclusions. The revealed patterns substantiate the effectiveness of LEAE for chronic lower limb ischemia.
Introduction. Reperfusion-reoxygenation syndrome (RRS) after revascularization of the lower limbs in obliterating atherosclerosis of the arteries is accompanied by a violation of the oxygen transport function of the blood (OTFB) and the content of gas transmitters (GTs). Reperfusion injury affects not only the tissues of the lower limbs, but also of anatomically distant organs, which supposes that effective RRS correction is required. Aim. To study the effect of Corvitin on the OTFB parameters and the content of GT of nitrogen monoxide (NO) and hydrogen sulfide (H2S) in the venous blood of the forearm after revascularization of the lower limb in chronic atherosclerotic occlusion of the superficial femoral artery (SFA). Materials and methods. The study included 118 male patients. Revascularization of the lower limb was carried out by the method of loop endaterectomy from the SFA. Patients of group I (n=52) received traditional medication, 51 patients of group II additionally received Corvitin. In the blood from the vein of the elbow bend before the operation, on the 3rd and 8th days after it, the indices of OTFB and GTs were determined. Results. In group I, on the 3rd day after surgery, pO2 increased in relation to healthy individuals by 5.2–18.5%, while pCO2 decreased by 4.8–6.7%, depending on the stage of initial ischemia. The concentrations of NO and H2S increased by 9.2–50.1% and 9.2–21.1%, respectively. The increase in the parameters of hyperoxemia, hypocapnemia and GT after the return of blood circulation decreases with the use of Corvitin (p˂0.05). By the end of the early postoperative period, the indicators of OTFB and GT not only return to their initial values, but also do not significantly differ from the group of healthy individuals (p˃0.05). Conclusion. The use of Corvitin effectively corrects violations of OTFB and GT during ischemia-reperfusion of the lower limbs, which prevents tissue reperfusion damage.
Background. Ischemia-reperfusion of the lower limbs in atherosclerosis of their arteries is accompanied by impaired oxygen transport function (OTF) and the content gas transmitters (GT) of blood, which needs adequate correction. Purpose. To study the effect of corvitin on the parameters of OTF and GT of nitrogen monoxide and hydrogen sulfide in venous blood after revascularization of the lower limb in chronic atherosclerotic occlusion of the superficial femoral artery (SFA). Material and methods. Revascularization of the lower limbs in 103 patients was performed by loop endaterectomy from SFA. Patients of group I (n=52) received traditional medication support, II (n=51) - corvitin. The indices of OTFB and GT in the venous blood of the lower and upper limbs were determined before the operation, on the 3rd and 8th days after it. Results. The increase in the parameters of hyperoxemia, hypocapnemia and GT concentration in the postoperative period decreases with the use of corvitin. Conclusions. The use of corvitin reduces disturbances in OTFB and GT content during ischemia-reperfusion of the lower limbs.
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