[Results of using various methods of autovenous femoropopliteal bypass grafting below the knee-joint fissure]. / Rezul'taty primeneniya razlichnykh sposobov autovenoznogo bedrenno-podkolennogo shuntirovaniya nizhe shcheli kolennogo sustava.

The objective of the study was to improve therapeutic outcomes in patients presenting with lower limb critical ischaemia by means of optimizing the technique of femoropopliteal bypass grafting. The authors analysed the results of comprehensive examination and treatment of a total of 90 patients presenting with critical lower limb ischaemia on the background of atherosclerotic lesions of arteries of the femoropopliteal and crural segments. Depending on the technology of performing femoropopliteal bypass grafting, the patients were subdivided into three groups each consisting of 30 subjects. The groups were comparable by gender, age, concomitant diseases, degree of damage to arteries of the femoro-popliteal-crural segment, and the state of the distal vascular channel. Group One patients underwent conventional autovenous bypass grafting with a reversed great saphenous vein. Group Two patients endured surgery according to the "in situ" technique. Group Three patients were subjected to an original technology of bypass grafting using a free autovenous graft with destroyed valves without reversion of the vein. It was demonstrated that the use of a free autovenous transplant with destroyed valves increased the volumetric blood flow through the shunt in the remote postoperative period 2.4-fold as compared with the reversed vein and 1.7-fold as compared with the "in situ" autovein. The proposed technique of femoropopliteal bypass grafting made it possible in the immediate postoperative period to decrease the rate of early postoperative complications by 23.4% as compared with the option of using the reversed vein and by 13.3% as compared with the "in situ" technique, as well as to lower the incidence rate of late shunt thromboses by 40 and 13.3%, respectively, and the number of limb amputations by 30 and 6.7%, respectively. The use of a free autovenous graft with destroyed valves is pathogenetically justified and makes it possible to optimize the results of treatment of patients.

[Free autovenous graft with destructed valves in treatment of severe ischemia of lower extremities]. / Lechenie kriticheskoi ishemii nizhnikh konechnostei s ispol'zovaniem svobodnogo autovenoznogo transplantata s razrushennymi klapanami.

AIM: to improve treatment of patients with severe atherosclerotic lesion of lower extremities arteries followed by critical ischemia by optimization of femoropopliteal bypass surgery. MATERIAL AND METHODS: Treament and survey of 60 patients with severe atherosclerotic lesion of femoropopliteotibial segment and critical lower limb ischemia were analyzed. Patients were divided into 2 groups depending on technique of femoropopliteal bypass. Conventional in situ autovenous technique was used in group 1. In the second group we used original method of free autovenous graft with destructed valves. RESULTS: Technique of free autovenous graft with destructed valves decreases incidence of early postoperative complications by 13.3%, remote thrombosis of graft by 13.3%. Also it increases physical and mental components of health by 7.9% and 3.1% respectively. CONCLUSION: Use of free autovenous graft with destructed valves is reasonable and improves results of treatment.

EFFICACY OF FREE AUTOVENOUS TRANSPLANT IN FEMORAL-POPLITEAL BYPASS BELOW THE JOINT SPACE OF THE KNEE.

The article presents an analysis of complex examination and treatment of 60 patients with critical ischemia of the lower extremities due to atherosclerotic lesions of femoral-poplitealtibia segment. Typical traditional autovenous bypass of reverse big saphena was performed for the first (control) group of patients. The operation, which used an original technology by free autovenous transplant with collapsed valves without vein reverse, was completed for the second (experimental) group of patients. An application of original treatment technology allowed an increase of blood flow volume in the extremity in 1,5 times, an arterial blood flow - in 1,6 times, rate of microcirculation - in 1,3 times. An early postoperative complications were decreased on 23,4%, the late shunt thrombosis - on 40%. Long-term shunt passability was improved in 2,6 times and physical component of health - on 10,6%, psychological - on 4,3%. The shunt functioned in 36,7% of the first group and in 83,3% patients of the second group after two years since operation. The extremity was saved in 60% of the first group and 90% patients of the second group.