Surgical treatment of patients with atherosclerotic occlusion of the aortoiliac segment combined with distal-bed lesions

Gavrilenko A.V., Egorov A.A., Kotov A.E., Mamukhov A.S., Molokopoi S.N.

Department of Vascular Surgery Federal Facility «В V. Petrovsky Russian Research Centre of Surgery» under Russian Academy of Medical Sciences, Moscow, Russia

Analysed herein are the outcomes of surgical management of a total of 108 patients presenting with atherosclerotic alterations in the aortoiliac segment in a combination with distal-bed lesions. All patients were subdivided into 3 groups. Group One patients were subjected to surgical treatment consisting in isolated aortoiliac bypass grafting. The deep femoral artery according to the findings of the angiographic study appeared to be large and anastomosed with the popliteal artery. Group Two patients underwent simultaneously performed reconstructions on the aortofemoral segment in a combination with femoropopliteal bypass grafting above and below the knee-joint fissure. Reconstructions in Group Three patients were supplemented with indirect revascularizations of the extremities. The operations performed were represented by the following interventions: arterialization of the venous blood flow of the foot, lumbar sympathectomy, revascularizing osteotrephi nation, administration of gene-engineering complexes.

The reconstructions in the aortofemoral segment in this group of patients were supplemented with indirect revascularization due to the presence of diffuse lesions of the distal-bed arteries. Analysing both immediate and remote outcomes of surgical management of these patients made it possible to compare its therapeutic efficacy in the represented groups.

KEY WORDS: atherosclerosis, aortofemoral bypass grafting, distal bed, femoropopliteal bypass grafting, indirect revascularizations.

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