Novosti
Khirurgii

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Year 2014 Vol. 22 No 3

GENERAL AND SPECIAL SURGERY

B.S. SUKOVATYKH1, L.N. BELIKOV2, O.A. RODIONOV2, A.O. RODIONOV1

THE CHOICE OF RECONSTRUCTIVE OPERATION AT OCCLUSIVE-STENOTIC LESIONS OF THE ABDOMINAL AORTA, ILEAC AND INFRACLAVICULAR ARTERIES IN HIGH RISK PATIENTS

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

Objectives. To study the efficiency of axillofemoral xenoprosthetics in the treatment of the lower limbs critical ischemia in the combined aortic, iliac, infraclavicular lesions in high-risk patients.
Methods. The results of examination and treatment of 45 patients with the lower limb critical ischemia, based on bilateral lesions of aorto-iliac segment of the atherosclerotic etiology have been analyzed. The patients were divided into 2 groups. The first group consisted of 30 patients underwent the typical axillary-femoral bypass by synthetic prosthesis. The second group included 15 patients the axillofemoral xenoprosthesis by the original method with the proximal anastomosis creation between the axillary artery and biological prosthesis of internal thoracic arteries of a bull “end to end” was performed. The formation of a tunnel and conducting the vascular prosthesis in it along the front surface of a body was carried out with the help of a special device, consisting of a metal tube, removable handle and two olives of 10 and 20 mm in diameter. The smaller olive is oriented for making the tunnel from the femoral up to the axillary artery. The bigger olive is needed for extension of the tunnel.
Results. All patients had a high operative-anesthesiological risk due to the severe accompanying diseases in the decompensation stage. The use of the original treatment technology permits in the immediate postoperative period to increase the volume of the blood flow through the shunt in 2-folds, reduce the number of postoperative complications by 10%. In the distant postoperative period the average term of shunt functioning increased in 1,8-folds, the clinical status rose by 26,6% and the number of amputation reduces by 6,7%. No patients both in the first and second groups complained of undue fatigability of the upper limbs, where blood flow was redirected to the ischemic lower limb.
Conclusions. The use of axillofemoral biological xenoprosthesis is pathogenetically grounded for high risk patients with combined occlusive-stenotic lesions of the aorta and iliac and subclavian arteries.

Keywords: obliterating atherosclerosis, Leriche’s syndrome, stenosis of the infraclavicular artery, critical ischemia, high risk, axillofemoral bypass, axillofemoral xenoprosthesiss
p. 337 – 343 of the original issue
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Address for correspondence:
305041, Rossiyskaya Federatsiya, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
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 LN. MD, a head of the vascular surgery department of RBME “Kursk City Clinical Emergency Hospital”.
Rodionov O.A. An intern of the vascular surgery department of RBME “Kursk City Clinical Emergency Hospital”.
Rodionov A.O. An intramural post-graduate student of the general surgery chair of SBEE HPE “Kursk State Medical University”.
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