A.V. MAKSIMOV^1,2, S.M. HIZRIEV²

¹Republican Clinical Hospital of the MH of RT, 138 Orenburgsky Trakt, Kazan, Russian Federation, 420064

²Kazan State Medical Academy, 36 Butlerov St., Kazan, Russian Federation, 420012

Maksimov A.V. — D. Med. Sc., Head of the Vascular Surgery Department № 1, Associate Professor of the Department of Cardiology, Endovascular and Cardiovascular Surgery, tel. +7-917-877-16-65, e-mail: maks.av@mail.ru

Hizriev S.M. — Applicant of the Department of Cardiology, Endovascular and Cardiovascular Surgery, tel. +7-919-696-66-22, e-mail: seyfedin005@gmail.com

Immediate and long-term (24 months) results of femoropopliteal reconstructions using PTFE-grafts in patients with critical limb ischemia are presented. The reason for autologous vein rejection was its absence in 49 (47.1%) cases (in 11 cases — anatomical deficiency, in 38 cases it used in previous reconstruction), severe somatic status of the patient and his advanced age — 29 (27.9%), the need for distal revascularization of the lower leg in patients with trophic disorders with concomitant aortofemoral reconstruction (23, 22.1%), intraoperative autovenous bypass thrombosis (3, 2.9%). Bypass thrombosis occurred in 8 patients (7.7%). Reintervention by thrombectomy or repeated bypass surgery was effective in 5 cases. Primary patency was 92.3%, secondary — 97.1%. Achieved 3 major amputations (2.9%). There was no mortality. Limb salvage was 80.2% and 74.7% at 1 and 2 years respectively. Two-year survival rate was 83.0%. The pain syndrome disappeared in 89.5% of cases. After 9 months this syndrome mentioned by only 6.0% of patients. Later its frequency increased again reaching rate of 11.1% at 2 years. Trophic disorders regressed after 3 months in 89.8% of patients, at the first year surveillance — in 94.2% and to the end of the second year — in 96.2% of them.
Key words: critical limb ischemia, femoropopliteal segment, PTFE-graft.

REFERENCES

1. Norgren L., Hiatt W.R., Dormandy J.A. et al Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European J. of Vascular and Endovascular Surgery, 2007, vol. 33, suppl.1, pp. S1-S75.
2. Goodney P.P., Beck A.W., Nagle J. et al. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg, 2009, vol. 50, pp. 54-60.
3. Kunlin J. Le traitment de l, arterite obliterante par la grefte veineuse. Arch. Mal. Coeur, 1949, Vol. 42, P. 371-372.
4. Bradbury A.W., Adam D.J., Bell J. et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received. J Vas Surg, 2010, vol. 51, supplement S, pp. 18S-31S.
5. Conte M.S. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia. J Vasc Surg, 2010, vol. 51, supplement S, pp. 69S-75S.
6. Natsional’nye rekomendatsii po vedeniyu patsientov s sosudistoy arterial’noy patologiey (Rossiyskiy soglasitel’nyy dokument). Chast’ 1. Perifericheskie arterii [National recommendations for the management of patients with arterial vascular pathology (Russia conciliation document). Part 1. Peripheral artery]. Moscow: Izd-vo NTsSSKh im. A.N. Bakuleva, 2013. 78 p.
7. Cardia G., Cianci V., Merlicco D. Reoperation on the femoral arterial bifurcation: technical notes and surgical strategy. Chir. Ital, 2002, vol. 54, no. 4, pp. 487-493.
8. Usmanov N.U., Khalikov E.Kh., Gaibov A.D., Egorov Kh.N. Intraoperative angiography in reconstructive surgery of aorto-iliac occlusive. Khirurgiya, 1990, no. 5, pp. 79-82 (in Russ.).
9. Belov Yu.V., Stepanenko A.B., Gens A.P., Khalilov I.G. Evaluation of the results of surgical treatment of patients with multiple lesions of arteries of the lower extremities. Khirurgiya, 2001, no. 10, pp. 35-41 (in Russ.).