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Khirurgii

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Year 2015 Vol. 23 No 6

GENERAL & SPECIAL SURGERY

B.S. SUKOVATYKH1, L.N. BELIKOV2, M.B. SUKOVATYKH1, D.V. SIDOROV1, E.B. INOCHODOVA

FEMOROPOPLITEAL BYPASS BY FREE AUTOVENOUS GRAFT BELOW THE KNEE-JOINT SLOT IN THE TREATMENT OF CRITICAL LIMB ISCHEMIA

SBEE HPE "Kursk State Medical University" 1,
RBME "Kursk City Clinical Emergency Hospital" 2,
The Russian Federation

Objectives. To optimize treatment results of patients with critical ischemia of lower extremities caused by occlusive and stenotic lesions of the femoral-popliteal arterial segment by means of the femoral popliteal bypass surgery.
Methods. The analysis of complex examination and treatment of patients (n=60) with critical ischemia of lower extremities with atherosclerotic lession was done. The ischemia was caused by atherosclerotic occlusion of a femoral-popliteo-tibial segment. There were 55 males and 5 females; age of the patients ranged between 52-78 years. All patients were divided into two groups depending on the technique of femoral-popliteal bypass grafting. Each group consisted of 30 patients. The patients (the 1st group, control) were treated by common bypass graft using reverse greater saphenous vein. The patients of the 2nd group was underwent to the operation made according to the original technology using free venous graft with destruction of the venous valves without vein reversion.
Results. An advantage of the technique is that it permits to increase the volume blood flow in 1,5 fold, magisterial blood flow in 1,6 fold, microcirculation in 1,3 fold, volume blood flow via graft in 4,75 fold in the early incisional period, to decreases the incidence of early postoperative complications by 23,4%: graft thrombosis – by 6,7%, wound contamination – by 13,2%, lymphorrhea – by 3,3%. In the late incisional period it managed to reduce the quantity of late graft thrombosis by 40%, to improve long-term vein graft patency in 2,6 fold and quality of life by 10,6% (physical component ) and by 4,3% (mental one). In 2 years after operation the graft has been functioning in 36,7% of patients (the 1st group) and 83,3% of patients (the 2nd group). It allowed saving an extremity in 60% (the 1st group) and in 90% (the 2nd group) of patients.
Conclusion. The technique of femoro-popliteal bypass grafting using free venous graft with destroyed valves is considered to be pathogenetically justified and permits optimizing treatment results.

Keywords: atherosclerosis, autovein, below-knee femoro-popliteal bypasses grafting, volume blood flow, long-term vein graft patency, graft thrombosis, incisional period
p. 637-643 of the original issue
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Address for correspondence:
305041 Russian Federation,
Kursk, ul. K.Marksa, d. 3,
GBOU VPO "Kurskiy
gosudarstvennyiy
meditsinskiy universitet",
kafedra obschey khirurgii,
tel. office 8 4712 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE "Kursk State Medical University".
Belikov L.N. MD, a head of the vascular department of RBME "Kursk City Clinical Emergency Hospital".
Sukovatykh M.B. PhD, an associate professor of the general surgery chair of SBEE HPE "Kursk State Medical University".
Sidorov D.V. A clinical intern, applicant of the general surgery chair of SBEE HPE "Kursk State Medical University".
Inochodova E.B. A specialist of ultrasound diagnostics of RBME "Kursk City Clinical Emergency Hospital".
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