Peculiarities of performing hybrid operation in a patient with atherosclerosis of lower limbs and developed critical ischaemia

Uchkin I.G.^1,3, Shugushev Z.Kh.^1,4, Vikhert T.A.^1,2, Zudin A.M.^1,4, Gonsales A.K.¹, Tarkovskii A.A.^1,3

1) Department of Vascular Surgery No 2, N. A. Semashko Central Clinical Hospital No 2, Open Joint-Stock Company «Russian Railways»
2) Department of Instrumental Diagnosis, Russian National Research Medical University named after N.I. Pirogov
3) Department of Vascular Surgery of the Scientific Research Centre, I.M. Sechenov First Moscow State Medical University
4) Chair of Hospital Surgery, Medical Department, Russian University of Friendship of Peoples, Moscow, Russia

Currently, there is a tendency towards an increase in the incidence rate of cardiovascular disease. According to the data of the World Health Organization the incidence rate of obliterating diseases of peripheral arteries varies from 5 to 10%. Diseases of peripheral arteries manifest themselves by such a severe condition as lower-limb critical ischaemia. Most often lower-limb chronic critical ischaemia develops in patients with multi-level lesions of the arterial bed. Treatment of such patients constitutes a serious problem since it requires large-scope revascularization. The authors describe a clinical example of a hybrid operation in a patient with atherosclerosis of lower-limb arteries on the background of critical ischaemia of the lower extremities on the background of type 2 diabetes mellitus. The hybrid intervention was performed in the scope of balloon angioplasty and stenting of the right deep femoral artery with simultaneous loop semiclosed thromboendarterectomy from the right common femoral artery, superficial femoral and popliteal artery with balloon angioplasty of the right superficial femoral artery with mechanic recanalization and balloon angioplasty of the popliteal artery, anterior tibial artery, and peroneal artery. The next stage consisted in amputation of the anterior portion of the right foot according to the Chopart’s technique with skin plasty. Resulting from the operation on the background of further angiotropic and rheological active therapy with PGE-1 preparation VAP-20 we managed to save the patient’s limb and to limit to minor amputation.

Hybrid operative interventions should be carried out in order to achieve maximal revascularization when it is not possible to obtain a favourable result by a reconstructive or endovascular intervention alone.

KEY WORDS: hybrid interventions, lower-limb arteries, lower-limb critical ischaemia.

P. 169

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