Choosing the method of reconstructive operation in patients with atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia

Kazakov Yu.I.^1,2, Lukin I.B.²

1) Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation,
2) Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia

Presented herein are remote results of surgical treatment of 101 patients with atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The choice of the reconstructive operation was made based on the developed criteria. Femoral-popliteal shunting into the isolated segment of the reversed great saphenous vein was performed in 48 (47.52%) patients, and 53 (52.48%) patients underwent distal femoral-tibial bypass grafting according to the in situ technique. The five-year patency of the graft in these groups was identical, amounting to 54.17% and 58.49%, respectively. In order to predict the duration of bypass graft patency in the isolated segment of the popliteal artery we worked out criteria of competence of the collateral blood flow. We also defined more exactly the indications for applying a relieving arteriovenous fistula in distal femorotibial shunting. When deciding upon a method of operative treatment, preference is given to shunting into the isolated popliteal artery in sufficient collateral blood flow.

KEY WORDS: critical ischaemia, femoropopliteal shunting, femorotibial shunting, surgical decision making.

P. 140

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