RESUMEN
We analysed the results of surgical treatment of 40 patients with lower limb critical ischaemia induced by atherosclerotic lesion of arteries of the femoropopliteotibial segment with dubious outflow pathways. The patients were divided into two groups of 20 each. Group One patients underwent autovenous femoropopliteal or tibial bypass grafting below the fissure of the knee joint and Group Two patients were subjected to profundoplasty with closure of the arteriotomic opening with an autovenous patch. The outflow pathway index in Group One amounted to 7.5±0.09 and in Group Two to 7.45±0.08. Our findings suggest that the use of profundoplasty as reconstructive operation in patients with dubious outflow pathways is pathogenetically substantiated, because it makes it possible to decrease the rate of early postoperative complications by 20% and that of late bypass thromboses by 25%, as well as to increase the level of the physical component of health by 12.1% and that of mental health by 3.2%. A conclusion drawn is that performing profundoplasty in this cohort of patients is appropriate and effective.
Asunto(s)
Isquemia , Extremidad Inferior , Procedimientos Quirúrgicos Vasculares , Arteria Femoral/cirugía , Humanos , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Arteria Poplítea/cirugía , Grado de Desobstrucción VascularRESUMEN
AIM: To compare synthetic and biological prostheses for femoral bypass surgery. MATERIAL AND METHODS: There were 40 patients with critical ischemia of lower extremities due to atherosclerotic lesion of aorto-iliac segment and severe comorbidities. They were divided into 2 groups by 20 patients. C-shaped femoro-femoral bypass with synthetic polytetrafluoroethylene and lavsan prostheses was performed in the first group and S-shaped bypass procedure with biological prosthesis from the internal thoracic arteries of the bull - in the second group. RESULTS: Biological prosthesis is associated with reduced early postoperative morbidity by 10%, late graft thrombosis incidence by 20% and increased physical and psychological health by 7.1%. CONCLUSION: S-shaped femoro-femoral bypass with a biological prosthesis from the internal thoracic arteries of the bull is pathogenetically substantiated and effective.
Asunto(s)
Implantación de Prótesis Vascular , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Arterias Mamarias/trasplante , Enfermedades Vasculares Periféricas/cirugía , Injerto Vascular/métodos , Anciano , Animales , Aorta Abdominal/cirugía , Prótesis Vascular/clasificación , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Bovinos , Femenino , Arteria Femoral/cirugía , Humanos , Arteria Ilíaca/cirugía , Isquemia/etiología , Masculino , Enfermedades Vasculares Periféricas/complicaciones , Enfermedades Vasculares Periféricas/diagnóstico , Politetrafluoroetileno/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
An analysis of results of experimental research was made in 60 patients with critical ischemia of lower extremities due to bilaterally atherosclerotic lesions of aorto-iliac segment, which had a high operationally anaesthetic risk. Synthetic polytetrafluoethylene prosthesis or biological shunt from internal pectoral bull arteries were used as a shunt. Revasculization was performed through the system of arteria profunda femoris considering multilevel lesions of lower limb arteries. An application of biological prosthesis allowed decreasing the rate of early postoperative complications on 13,3% , late thromboses--on 30%, extending the medium term of shunt functioning in 1.8%, improving physical component of health on 12.8% and mental--on 9.1% during the immediate postoperative period. The experiments on rabbits were carried out. It was shown, that biological prosthesis had the greatest biological compatibility.
Asunto(s)
Arteria Axilar/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Arteria Femoral/cirugía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Anastomosis Quirúrgica , Animales , Modelos Animales de Enfermedad , Enfermedad Arterial Periférica/diagnóstico , Complicaciones Posoperatorias , Diseño de Prótesis , Conejos , Índice de Severidad de la EnfermedadRESUMEN
UNLABELLED: Analysed herein are the results of an experimental study performed on 30 rabbits and a clinical study of treating a total of 60 patients presenting with critical ischaemia of lower limbs on the background of bilateral atherosclerotic lesions of the aortoiliac segment and running high operational-anaesthesiological risk. The animals were subdivided into three groups: an intact group consisting of 6 animals and two study groups comprising 12 rabbits each. In the first study group onto the wall of the abdominal aorta we implanted a synthetic polytetrafluoroethylene prosthesis, the second study group animals received biological graft "Kemangioprotez" from bovine internal thoracic arteries. The biological prosthesis on day three after implantation onto the arterial wall induced 3.2 times and on day seven 1.2 times more pronounced inflammatory reaction than the polytetrafluoroethylene prosthesis. 30 days after implantation of the synthetic graft the degree of repair connective-tissue processes in the arterial wall was 1.8-fold and 70 days after was 3.3-fold more pronounced than after implantation of the biological prosthesis at the same terms. In the connective-tissue capsule around the synthetic prosthesis predominated cellular elements while around the biological prosthesis - fibrous structures predominated. The patients were subdivided into 2 groups consisting of 30 patients each. In Group One patients the shunt used was a synthetic polytetrafluoroethylene prosthesis, in Group Two being a biological graft from bovine internal thoracic arteries. All patients suffered from severe concomitant diseases in the decompensation stage and a multi-level lesion of lower-limb arteries. Revascularization of the ischaemized extremity was carried out through the system of the deep femoral artery system. The use of a biological prosthesis made it possible in the immediate postoperative period to decrease the frequency of early postoperative complications by 13.3%, that of late graft thromboses by 30%, to prolong the average term of grafts functioning 1.8-fold, to increase the physical component of health by 12.8% and the mental one by 9.1%. CONCLUSION: For femorosubclavian shunting in high-risk patients it is appropriate to use a biological graft while establishing a distal anastomosis with the deep femoral artery.
Asunto(s)
Bioprótesis , Implantación de Prótesis Vascular , Arteria Femoral/cirugía , Oclusión de Injerto Vascular , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Arteria Subclavia/cirugía , Anciano , Animales , Aorta Abdominal/patología , Aorta Abdominal/fisiopatología , Bioprótesis/efectos adversos , Bioprótesis/estadística & datos numéricos , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/prevención & control , Humanos , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Modelos Animales , Evaluación de Resultado en la Atención de Salud , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Politetrafluoroetileno/uso terapéutico , Conejos , Estudios Retrospectivos , Ajuste de Riesgo , Grado de Desobstrucción VascularRESUMEN
It was analyzed the treatment results of 60 male patients with critical limb ischemia in case of atherosclerotic lesions of the aorta-iliac segment and severe somatic diseases. All patients were divided into 2 groups. Every group consisted 30 patients. The first group included axillary-femoral bypass by using of synthetic polytetrafluoroethylene prosthesis. The second group - by using of bioprosthesis of bull's internal thoracic arteries. Using of bioprosthesis allows to reduce early postoperative complications in intermediate postoperative period on 13.3%, late bypass thrombosis on 30%. Also there was elongation of average time of bypasses functioning in 1.8 times. Physical health was increased on 12.8%, mental - on 9.1%.