Liulka O. M., Liakhovskyi V. I., Niemchenko I. I., Puzyrov G. S., Sapun L. V.


About the author:

Liulka O. M., Liakhovskyi V. I., Niemchenko I. I., Puzyrov G. S., Sapun L. V.



Type of article:

Scentific article


From 2 to 7% of the total population aged from 50 to 75 years old suffer from obliterating atherosclerosis of the aorta and lower extremities arteries. Atherosclerotic lesions of the arteries of the lower extremities are the most common disease, which leads to decreasing quality of life and death of patients, especially the old and the elderly. Almost 90% of all arterial operations are performed on atherosclerotic lesions of the abdominal aorta and the femoral-popliteal segment. For most patients surgical interventions are performed only at III-IV stages of obliterating atherosclerosis of the lower extremities. At the same time, the threat of ineffective results of reconstruction and restoration operations and the occurrence of complications increases. Unfortunately, the number of unsuccessful results in surgical treatment of critical ischemia of the lower extremities remains high. Thus, nowadays the issues of vascular surgery remain the improvement of the surgical technique of surgical interventions on atherosclerotic occlusive-stenotic lesions of the major arteries of the lower extremities. The purpose of the study was to conduct an analysis of scientific literature devoted to improving the restoration of the blood flow of the lower extremities when performing reconstructive operations on arteries in patients with obliterating atherosclerosis. In severe chronic ischemia of the lower extremities, reconstructive surgery on the vessels is the only way to save the limb, and often the patient’s life. They are performed, according to various authors, in 41,6-78,4% of cases. This kind of surgical intervention does not require deep anesthesia and runs without opening the cavities, which greatly reduces the intra- and postoperative risk. Recovery operations are performed in 90% of cases under epidural anesthesia. In 56,2% of cases, femoral-popliteal bypassing performed with distal vascular anastomosis formation above the articular joint of the knee, and in 43,8% – below the articular joint of the knee. The timeliness of the reconstructive operation is of great importance. This is due to the fact that the preservation of the distal bed, and hence the patency of the shunts, is better if the intervention is performed before the development of chronic critical ischemia of the lower extremities. In cases of critical ischemia, 76% of patients over the age of 60 without forced revascularization of the affected limb are forced to perform high amputations. However, despite the progress of angiology, the achievement of modern anesthesiology and intensive care, restoration operations on the femoral ankle-neck segment remain interventions with an increased risk for the patient’s life. The main cause of unsuccessful reconstructions is postoperative complications that occur in 40-60% of patients. They distinguish local (specific) and general (non-specific) complications both in the early (before year) and remote postoperative period. The number of nonspecific complications significantly exceeds the number of specific (64.8% and 35.2% respectively). The leading postoperative complication, especially in patients of the older age group, is acute myocardial infarction (9.2%). Specific complications of the early postoperative period in reconstructive angiosurgery include thrombosis, bleeding and suppuration in the areas of vessel reconstruction or prosthetic reconstruction. They occur in 8.9 – 44.2% of cases. Technical reasons for unsuccessful reconstructions are due to improper superimposition of vascular anastomoses, inadequate selection of prosthesis material, technical untraining of the surgeon. The passage of the femurpopliteal or femoral shunt depends on the type of operation, the material from which the prosthesis is made, its length, the state of the circulatory system of the patient’s blood. Therefore, the surgeon’s actions during reconstruction and restoration operations on the arteries of the lower extremities with their atherosclerotic lesions should be aimed at improving the diagnosis of the distal arterial bed, improving the outflow of blood and improving the technical methods of performing surgical interventions Thus, the main cause of the early thrombosis of alo-autoshunts is the violation of the technical requirements for the formation of vascular anastomosis. Improvement of the results of treatment of these patients will be facilitated, first of all, by the improvement of the surgical technique of conducting surgical interventions in atherosclerotic occlusive and stenotic lesions of the major arteries of the lower extremities.


atherosclerotic lesion, arteries of the lower extremities, reconstructive surgery, complications


  1. Pokrovskiy AV, redaktor. Klinicheskaya angiologiya: Rukovodstvo. M.: OAO «Izdatel’stvo meditsina»; 2004. 888 s. [in Russiаn].
  2. Maystrenko DN, Zherebtsov FK, Osovskikh VV. Sovremennyye diagnosticheskiye tekhnologii v opredelenii taktiki lecheniya bol’nykh s obliteriruyushchim aterosklerozom sosudov nizhnikh konechnostey. Vestnik khirurgii im. I.I. Grekova. 2009;168:41-6. [in Russiаn].
  3. Dibirov MD, Dibirov AA, Gadzhikuradov RN. Distal’nyye rekonstruktsii pri kriticheskoy ishemii nizhnikh konechnostey u bol’nykh starshikh vozrastnykh grupp. Khirurgiya. 2009 Yanv 8;1:49-52. [in Russiаn].
  4. Іnter-Society Consensus for the Management of Peripheral Arterial Disease (TASC ІІ). Eur. j. Vasc. Endovasc. Surg; 2007. 33 р.
  5. Nehler MR, Wolford HD. Saunders natural history and nonoperative treatment of chronic lover extremity ischemia. Vascular Surgery. Rutherford: Elsevier; 2005. p. 1083-94.
  6. Lyulʹka YeM, Bezkorovaynyy OM, Sapun LV, Lyakhovsʹkyy VI. Osoblyvosti khirurhichnoho likuvannya khvorykh na obliteruyuchyy ateroskleroz arteriy nyzhikh kintsivok z hniyno-nekrotychnymy uskladnennyamy. Klinichna khirurhiya. 2015 Hrud 24;11.2:86. [in Ukrainian].
  7. Tkachenko AN, Zharkov AV, Antonov DV. Amputatsiya nizhnikh konechnostey u bol’nykh pozhilogo i starcheskogo vozrasta pri obliteriruyushchem ateroskleroze. Vestnik SPbGU. 2011 Noyab 16;11(1):135-41. [in Russiаn].
  8. Ioskevich NN. Khirurgicheskoye lecheniye khronicheskikh ishemiy nizhnikh konechnostey pri ateroskleroticheskom porazhenii bedrennobertsovogo segmenta. Novosti khirurgii. 2007 Okt 12;15(3):107-17. [in Russiаn].
  9. Koshelev YuM, Varnavskikh VI, Dem’yanov AM. Endarterektomiya iz distal’nogo arterial’nogo rusla pri protezirovanii aorty i podvzdoshnykh arteriy. Vestnik khirurgii. 2005 May 12;164(3):75-8. [in Ukrainian].
  10. Momsen AH, Jensen MB, Norager CB. Drug therapy for improving walking distance in intermittent claudication: a systemic review and metaanalysis of robust randomized controlled studies. Eur. J. Vasc. Endovasc. Surg. 2009;38(4):463-74.
  11. Kokhan YeP. Poyasnichnaya simpatektomiya pri obliteriruyushchem ateroskleroze arteriy nizhnikh konechnostey i vozrast patsiyentov. Khirurgiya. 2000 Dek18;11:41-3. [in Russiаn].
  12. Skugar’ YuA. Rekonstruktivnyye operatsii na bedrenno-podkolennom segmente v sochetanii s poyasnichnoy simpatektomiyey. Khirurgiya. 2003 Noyab 26;11:8-10. [in Russiаn].
  13. Krotovskiy GS. Lecheniye bol’nykh s khronicheskoy kriticheskoy ishemiyey nizhnikh konechnostey s primeneniyem prostaglandina Ye1 na fone soputstvuyushchey ishemicheskoy bolezni serdtsa. Khirurgiya. 2004 Mart 19;3:31-4. [in Russiаn].
  14. Tiia S. Jamsen. Long-term Outcome of Patients with Claudication after Angioplasty of Femoropopliteal Arteries. Radiology. 2002 Febr 12;225(2):345-52.
  15. Alukhanyan OA. Osobennosti khirurgicheskoy taktiki pri kriticheskoy ishemii nizhnikh konechnostey u bol’nykh pozhilogo i starcheskogo vozrasta. Angiologiya i sosudistaya khirurgiya. 2003 Apr 14;4(3):106-9. [in Russiаn].
  16. Dudanov IP, Kapustin MYu, Soroka VV. Kompleksnoye lecheniye ateroskleroticheskikh porazheniy abdominal’nogo segmenta aorty, perifericheskikh arteriy s kriticheskoy ishemiyey nizhnikh konechnostey u bol’nykh preklonnogo i starcheskogo vozrasta. Med. akad. zhurn. 2007 Yanv 10;7(1):166-72. [in Russiаn].
  17. Selvin E, Erlinger Tp. Prevalence and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey. Circulation. 2004 Jun 7;110(6):738-43.
  18. Kannel W, Anderson K, Wilson P. Cardiovascular disease risk profiles. American Heart Journal. 1990;121:293-8.
  19. Merlini MP, van Dongen RJAM, Dusmet M. Surgery of the deep femoral artery. British Journal of Surgery. 1995 Jun 8;82(7):182-6.
  20. Dibirov MD. Khirurgicheskoye lecheniye bol’nykh pozhilogo i starcheskogo vozrasta s khronicheskoy ishemiyey pri distal’nykh okklyuziyakh. Vestnik khirurgii. 2000 May 16;159(4):85-8. [in Russiаn].
  21. Belov YuV. Taktika khirurgicheskogo lecheniya bol’nykh s diffuznym porazheniyem arteriy nizhnikh konechnostey. Khirurgiya. 1999 Dek;4:4-9. [in Russiаn].
  22. Rosenthal D. Remote superficial femoral artery end arterectomy and distal vein bypass for limb salvage: initial experience. J. Endovascular. Ther. 2003 Febr 12;10:121-5.
  23. Lemenev VL. Khirurgicheskoye lecheniye bol’nykh starshikh vozrastnykh grupp s kriticheskoy ishemiyey nizhnikh konechnostey pri okklyuzionnykh porazheniyakh aorty i podvzdoshnykh arteriy. Khirurgiya. 2002 Iyun’ 22;6:52-6. [in Russiаn].
  24. Mishalov VG, Chernyak VA. Mesto intraoperatsionnoy otsenki distal’nogo rusla v khirurgii obliteriruyushchego ateroskleroza arteriy nizhnikh konechnostey 3 i 4 stadii. Khirurgiya Ukrainy. 2008 Apr 12;4(dop):208-10. [in Russiаn].
  25. Losev RE, Burov YuA, Mikul’skaya YeG. Funktsional’no-anatomicheskiye predposylki revaskulyarizatsii bedrenno-podkolennogo arterial’nogo segmenta. Vestnik khirurgii im. I.I. Grekova. 2008 Yanv 20;1:18-21. [in Russiаn].
  26. Maksimov AV, Viktorov SV. Otdalennyy prognoz pri ateroskleroze aorto-bedrennogo segmenta bez operatsii. Angiologiya i sosudistaya khirurgiya. 2004 Mart 28;3:33-9. [in Russiаn].
  27. Belov YuV, Stepanenko AB, Gens AP, Khalilov IG. Khirurgicheskoye lecheniye bol’nykh s mnozhestvennym porazheniyem arteriy nizhnikh konechnostey. Angiologiya i sosudistaya khirurgiya. 2002 Yanv 20;8(1):72-9. [in Russiаn].
  28. Belov YuV. Rukovodstvo po sosudistoy khirurgii s atlasom operativnoy tekhniki. M.: De Novo; 2000. 448 s. [in Russiаn].
  29. Katel’nitskiy II, Katel’nitskiy IgI, Luk’yanov SV. Effektivnost’ kombinirovannogo lecheniya bol’nykh obliteriruyushchim aterosklerozom arteriy nizhnikh konechnostey. Kazanskiy nauchnyy meditsinskiy vestnik. 2013 Iyul’ 6;142(7):194-6. [in Russiаn].
  30. Chizhikov NV. Dinamika pokazateley endotoksinemii i antiendotoksinovogo immuniteta u bol’nykh s khronicheskoy ishemiyey nizhnikh konechnostey pri lechenii trentalom i vazaprostanom. Angiologiya i sosudistaya khirurgiya. 2002 Apr 12;8(3):25-9. [in Russiаn].
  31. Van Damme H. Crural Artery Bypass with the Autogenous Greater Saphenous Vein. Eur. J. Vascula. Endovascular. Surgery. 2003 Jun 24;26(6):635-42.
  32. Savel’yev VS, Koshkin VM, Karalkin AV. Patogenez i konservativnoye lecheniye tyazhelykh stadiy obliteriruyushchego ateroskleroza arteriy nizhnikh konechnostey. M.; 2010. 216 s. [in Russiаn]. 
  33. Byval’tsev VA, Belykh YeG, Alekseyeva NV, Sorokovikov VA. Primeneniye shkal i anket v obsledovanii patsiyentov s degenerativnym porazheniyem poyasnichnogo otdela pozvonochnika: metodologicheskiye rekomendatsii. Irkutsk: FGBU «NTSRVKH» SO RAMN; 2013. 32 s. [in Russiаn]. 

Publication of the article:

«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 36-40 pages, index UDK 616.137.83/93-004.6:617-089.843/844-06