COMBINED REVASCULARIZATIONS OF THE LOWER EXTREMITIES IN PATIENTS WITH CRITICAL ISCHEMIA

Yu.A. Burov, A.N. Moskalenko, V.A. Gavrilov, Ye.G. Mikulslcaya

Analysis was made of the results of surgical treatment of critical ischemia in 108 patients suffering from atherosclerosis obliterans of lower extremity vessels. To attain maximal revascularization of the lower extremities, revascularization osteotrepanations (ROT) of the bones as an "outflow" operation were performed concurrently in combination with reconstructive operations in 86 (79.6%) patients. There were two variants of the concurrent performance of direct and indirect revascularization of the lower extremities: 1) proximal combined revascularization of the lower extremities and 2) distal combined revascularization of the lower extremities. The proximal combined revascularization was accomplished when aorto-iliac lesions were coupled with femoro-popliteal occlusions. Vascular reconstruction in the aorto-femoral segment mandated blood flow restoration in the deep femoral artery. ROT of the bones in this case was performed from the upper third of the femur to the foot. The distal combined revascularization was carried out when femoro-popliteal lesions were coupled with occlusions of the distal segments of the extremity. The level up to which osteotrepanations were made was determined by the zone with the main blood flow. During reconstructive operations, restoration of the main blood flow in the popliteal artery and tibioperoneal trunk was regarded as optimal. ROT of the bones of the lower extremities brings about a mean 43.7% increase of the blood flow volume in the arteries. The combined revascularizations of the lower extremities allowed to obtain positive results in the early postoperative period in 83.4% of cases.

KEY WORDS: osteotrepanation, combined revascularization of the lower extremities, critical ischemia of the lower extremities.

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