[Efficacy of various types of femoropopliteal crural bypass grafting]. / Éffektivnost' razlichnykh vidov bedrenno-podkolenno-bertsovykh shuntirovanii

Over the period from 1997 to 2007 a total of 132 patients presenting with chronic lower-limb ischaemia underwent reconstructive bypass grafting operations performed at the Department of Cardiovascular Surgery of the Murmansk Regional Clinical Hospital named after P.A. Bayandin. Depending on the method of formation of the distal anastomosis the patients were subdivided into two groups: Group I with endarterectomy in the zone of the distal anastomosis, including 39 patients, and Group II without endarterectomy, comprising 93 patients. As the plastic material for bypass grafting we used autoveins in the "reverse" and "in situ" positions, allografts made of polytetrafluoroethylene (PTFE) or woven fabric, combined grafts. In the both groups prevailing were patients with critical ischaemia of the lower limbs. Thus, 20 (51.3%) patients had degree III ischaemia in Group One and 60 (64.5%) patients in Group Two, and 18 (46.2%) patients had ischaemia degree IV and 20 (21.5%), respectively. In order to evaluate the state of the distal bed we calculated the average score according to the Rutherford classification (Rutherford, et al., 1997), which amounted to 7.56 ±1.5 and 6.2±1.43 for Group I and II, respectively. The best patency and limb salvage rate were observed in autovenous bypass grafting according to the "in situ" technique without endarterectomy. Thus, the cumulative patency amounted to 21% and limb salvage to 29.4% after 5 years.

[Ways to improve patency of the femoral-popliteal-crural bypass grafts].

Chronic obliterating diseases of lower-limb arteries account for more than 20% of all manifestations of cardiovascular pathology. A surgical method of treatment for this pathology remains most effective. The types of operations below the inguinal fold currently used are as follows: bypass grafting, endarterectomy, and angioplasty. The vein is the material of choice and if it is not easily available allografts may be used. Differing elastic properties of the artery and prosthesis lead to progression of the neointima thus negatively affecting patency of bypass grafts. This article describes venous bypass grafts, their efficacy, methods of improving patency of allografts, as well as variants of combined operations.