INDIRECT REVASCULARIZATION OCCLUSION OF LOWER LIMB ARTERIES

Aslyaev A. L., Kushnaryova E. A., Stepanenko R. N., Kushnaryov A. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The treatment of occlusive diseases of lower limb arteries is one of the most actual and difficult problems of surgery. Performing reconstructive surgery is associated with a greater risk, and in 25-40% of patients to perform the intervention is not possible because of the prevalence of occlusive process. Such patients, as an alternative to amputation of the lower limb, in treatment shows the execution of the indirect revascularization (lumbar sympathectomy method revascularization osteotrephination). The aim of our research was to improve the results of surgical treatment of patients with occlusive diseases of lower limb arteries by stimulating the development of collateral circulation. The task of our research was to study the results of operations of indirect revascularization in patients with occlusive diseases of the lower limbs if you can not perform reconstructive surgery on the arteries of the lower extremities. Also studied the state of regional circulation in patients with occlusive diseases of the lower limbs before and after surgery. We have provided a method for crossing branches of the femoral and external iliac arteries, combined with unilateral lumbar sympathectomy and revascularization osteotrepanation for the purpose of indirect revascularization of the lower limbs. Results of treatment of 30 patients with obliterating atherosclerosis and diabetic angiopathy of lower extremities were analyzed in all patients were observed atherosclerotic changes of main arteries and ischemia III - IV degree with occlusion of the femoropopliteal segment, with complete obliteration of the posterior and anterior tibial arteries in most cases noted necrotic changes in the soft tissues and toes. The majority of patients chronic critical ischemia accompanied by comorbidities, impairing the general condition of the patient and for the underlying disease. We proposed operation was performed under endotracheal anesthesia. Adrectal cut, with extension to the inguinal ligament and parallel to layers cut the skin, subcutaneous fat, fascia, muscles of the vagina straight; last delayed medially, and bared preperitoneal tissue in the projection of the deep inguinal ring was exposed inferior epigastric artery (a. epigastrica inferior), which was resected and sutured as close as possible to the place of discharge from the external iliac artery. In addition, over the inguinal ligament was performed crossing branches and bandaging common femoral artery a. epigastrica superficialis (superficial epigastrium artery) and a. circumflexa ilium superficialis (superficial artery circumflex iliac bone) to be turned off from the bloodstream. Further, from the same access-way lumbar sympathectomy was performed at the level of L2-L4. After hemostasis, drainage of the retroperitoneal space, suturing and sealing surgical wounds produced revascularization osteotrepanation tibia according to the standard technique. The data of this study allow us to make conclusions about the effectiveness of the method of crossing branches of the femoral and external iliac artery to improve collateral circulation in occlusive diseases of lower limb arteries. We have the results of the indirect revascularization surgery were analyzed in 30 patients with obliterative atherosclerosis and diabetic angiopathy of lower extremities with inability to perform reconstructive surgery on the arteries. In 80% of patients operated on the background of significant hemodynamic improvement and increased collateral blood flow was able to keep the affected limb. Our proposed method of crossing of the external iliac artery branch (а еpigastrica inferior) and branches of the femoral artery - a. epigastrica superficialis (superficial epigastrium artery) and a. circumflexa ilium superficialis (superficial artery circumflex iliac bone) to be turned off from the circulation, provides collateral circulation increase in the lower limb, the suspension gives the spread of the pathological process. This method of treatment can be used both independently and in conjunction with lumbar sympathectomy and revascularization osteotrepanation. Clinical results were confirmed by the data ultrasound Doppler angioscanning and rheovasography. This method of indirect revascularization in the treatment of patients with occlusive arterial disease of the lower extremities is promising and warrants further study.

indirect revascularization, collateral blood supply, occlusion of lower limb arteries

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«Bulletin of problems biology and medicine» Issue 2 part 1 (128), 2016 year, 15-18 pages, index UDK 616.13 -004.6 -089.044