International Medical Journal, Vol. 22., Iss. 4, 2016, P. 24−27.
THE CHOICE OF SURGICAL TACTICS OF REPEATED INTERVENTIONS AFTER FEMOROPOPLITEAL BYPASS SURGERY IN LESIONS OF THE TIBIAL SEGMENT
V. T. Zaytsev Institute of General and Emergency Surgery, NAMS of Ukraine, Kharkiv, Ukraine
The increase in the number of vascular reconstructions performed in infrainguinal segment results in increase of the number of patients requiring reoperation for long−term complications after surgical revascularization of the extremities. To determine the optimal amount of re−intervention in thrombosis of femoropopliteal bypass, or at its inadequate functioning at stenotic lesion of the outflow pathways, the authors analyzed the results of surgical treatment of 75 patients. In 100 % of cases of atherosclerotic occlusion of the superficial femoral artery, the first stage of the distal femoropopliteal bypass was performed. As repeated operation, endovascular dilatation of stenoses of the distal zone (below the level of the distal anastomosis), tibial or (single, double) tibial artery bypass grafting, thrombectomy from the graft supplemented by the second level (tibial or (single, double) tibial bypass surgery); regrafting (repeated femoropopliteal or distal tibial) were performed. Determining the amount of re−intervention in the bloodstream included maximum possible number of tibial arteries and collaterals. Maximum use of the reserves of the peripheral channel when performing repeated operation for thrombosis of the graft ensured positive results in 82.7 % of cases; the results of repeated reconstruction were better than at preventive endovascular dilatation; preservation of shunt unloading at the level of the intermediate anastomosis with popliteal artery proved to be effective.
Key words: thrombosis of femoropopliteal bypass, repeated operation, acute limb ischemia.