This journal is
indexed in Scopus
Year 2020 Vol. 28 No 5
GENERAL & SPECIAL SURGERY
S.Y.GOROKHOVSKY 1, 2, A.A. LYZIKOV 1, M.L. KAPLAN 1, V.E. TIHMANOVICH 1
EXPEDIENCY AND OPTIONS FOR FUNCTIONAL CONTROL IN DETERMINING THE EXTENT OF SURGERY FOR OCCLUSIVE LESIONS OF THE LOWER EXTREMITY ARTERIES
Gomel State Medical University 1,
Gomel Regional Clinical Cardiology Center 2, Gomel,
Republic of Belarus
Objectives. To analyze and assess the efficiency of different strategies of the endovascular revascularization in patients with multilevel affection of lower extremity peripheral arteries based on angiographic and functional criteria.
Methods. The patients (n=114) with chronict multilevel of chronic lower extremity peripheral arteries were included in the study. The first group (n=60) comprised patients who underwent revascularization based on the angiographic criteria; the second one (n=40) included patients in whom the surgery was performed under both angiographic control and invasive intraoperative hemodynamic monitoring of the peripheral circulation; patients of the third group (n=14) were operated on the basis of peripheral fraction blood flow reserve (pFFR) determination in addition to the conventional angiography. Surgery results were assessed depending on value of ankle-brachial index (ABI); to compare the volume of intervention the estimated coefficient of revascularization was expressed as the ratio of the number of the treated segments to the number of affected ones.
Results. In all groups, the performed treatment resulted in the statistically significant (p<0,05) changes of ABI which was the evidence of therapy effectiveness. In the study groups ABI values after the operation amounted 0,8 (0,75; 0,8), 0,9 (0,8; 1) and 0,9 (0,9; 1), respectively, which is associated with a satisfactory result of treatment and prognosis of the disease. The given results were achieved in the presence of the statistically significant difference between groups in length of segments underwent angioplasty (mm) –170 (120; 200), 100 (80; 120) and 130 (115; 155), p=0,00007, stented segment length (mm)– 100 (60; 145), 60 (40; 100), 40 (30;40), р=0,00063 and revascularization coefficient: 1 (0,67; 1), 0,5 (0,5; 0,66) and 0,5 (0,5; 0,575), p<0,0001.
Conclusion. Methods of invasive functional assessment of the peripheral circulation in addition to the angiographic criteria allow reducing the volume of intervention with an optimal clinical result.
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246046, Republic of Belarus,
Gomel, Meditsinskaya str., 4,
Gomel State Medical University,
Department of Surgical Diseases No1,
Tel./fax: +375 232 49-19-54
Gorokhovsky Sergey Yu.
Lyzikov Alexey A., MD, Professor, Head of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
Gorokhovsky Sergey Yu., Roentgen-Endovascular Surgeon, Head of the Interventional Radiology Ward, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
Kaplan Mark L., PhD, Associate Professor of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
Tihmanovich Victor E., Assistant Lecturer of the Department of Surgical Diseases No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.