Objective. To propose the prognostication method for the complications occurrence after operative interventions, basing on application of multiparametric neuro-web clasterisation with subsequent elaboration of scale for their development risk stratification. Materials and methods. The indices of examination were analyzed in 411 patients, suffering obliterating atherosclerosis of main arteries of the lower extremities. The neuro-web clasterization, using a software raising NeuroXL Classifier, was conducted for more deep analysis of concomitant changes in the indices investigated for the risk prognostication optimization of the morbidity development in postoperative period. Results. The scale of the risk stratification for development of postoperative complications after interventions on the main arteries of the lower extremities proposed, takes into account multifactor character of clinic-anamnestic and laboratory-instrumental investigations. Taking into account the concomitant factors presence, which characterize the organs and systems state, they impact the choice of method of reconstructive operative intervention. Conclusion. Basing on data of the neuro-web clasterization, it is possible to prognosticate the complcations after operative intervention on the main arteries of the lower extremities. There were delineated four levels of the complications development risk in postoperative period: very high – 31-40 points, high – 21-30 points, moderate – 11-20 points, and low – 1-10 points.

Background. Among all postoperative complications associated with revascularization of atherosclerotic steno-occlusive process of the femoral-distal artery, thrombosis of the reconstruction segment is 6-32%. Objective. Prevention of thrombotic complications through vascular revascularization of the lower extremity by using a pathogenetically reasonable system of postoperative thromboprophylaxis. Methods. The study involved 97 patients with atherosclerotic stenotic-occlusive process of the infrainguinal artery in cases of stenotic-occlusive lesions of the tibial arteries. In order to study the state of the hemocoagulation system on patients, the methods for studying the indicators of coagulation, fibrinolytic and aggregation systems were used. Results. Development of hypercoagulable disorders in the patients who underwent endovascular revascularization of the arterial segment is more intense than in those who underwent open vascular revascularization methods. Hypercoagulation of blood at the intraoperative stage of revascularization takes place primarily due to the activity of factor IIa of the hemocoagulation cascade. Taking into account these circumstances, already at the surgery stage for thromboprophylaxis non-fractionated heparin (NFH) should be prescribed. At the same time for prevention of thromboembolic complications double anti-thrombocyte therapy: clopidogrel, acetylsalicylic acid should be prescribed. Conclusion. Hypercoagulant ability of the blood system, which develops after arterial reconstructive interventions, takes place against the background of low activity of the fibrinolytic blood system, nevertheless a gradual increase in the activity of the aggregation capacity of the blood. Development of hypercoagulable disorders at the intraoperative stage of surgery in the patients with endovascular methods of arterial reconstructions is more intense than in those treated with open methods of arterial revascularization. Taking into account these circumstances, already at the surgery stage for thromboprophylaxis an anticoagulant should be prescribed that has a targeted effect on factor IIa of the hemocoagulant cascade with simultaneous prevention of thromboembolic complications – double anti-thrombocyte therapy.

Introduction. Number of patients with obliterating lesions of the aorta and main arteries of the lower extermities has been steadily increasing every year. When choosing the scope of surgical treatment all the features of the multilevel stenotic-occlusive process of the infrainguinal arterial bed should be taken into account. Purpose. To improve the results of revascularization of the infrainguinal arterial bed by applying surgical intervention on profound femoral artery and endovascular methods to restore permeability of the outflow arteries. Materials and methods. The work is based on the results of examination and surgical treatment of 264 patients with stenotic-occlusive process of the infrainguinal arterial bed. There were four groups of patients. The basis of revascularization interventions on the infranguinal artery was shunt surgery. Bypass surgery was performed using a reverse autovein. The combined shunt was used for localization of the distal anastomosis at the level of the popliteal, shin arteries, tibioperinel trunk. Results. In atherosclerotic stenotic-occlusive lesions of the infrainguinal arterial bed of the lower extremity, the volume of surgical treatment depends on the level of the occlusive process, the functional state of the PFA and the blood flow pathways. And the method of surgical intervention in shunt interventions is determined by the type of distal lesion and the level of imposition of distal and proximal anastomoses. Conclusion. The use of endovascular methods of revascularization and reconstructive interventions on PFA in combination with femoral-distal shunt operations contributes to good and satisfactory results of surgical treatment of stenotic-occlusive processes of the infrainguinal arterial bed.

The use of endovascular techniques remains the only chance to restore blood flow under the conditions of a distal stenotic-occlusive process. Nevertheless, under the conditions of endovascular reconstructive surgery of the distal arterial bed, unsatisfactory results occur in 6-32% of cases in the form of thrombosis or restenosis of the reconstruction segment due to the progression of signs of limb ischemia. The aim is to improve the results of endovascular revascularization of multilevel atherosclerotic stenotic-occlusive femoral-distal arterial bed by surgical treatment of postoperative complicated forms of revascularized infrainguinal arterial bed. Materials and methods. 164 patients with multilevel stenotic-occlusive lesions of the femoral-distal arterial bed were under observation. Ultrasound dopplerography was used to select the volume of reconstructive intervention. Endovascular angioplasty of the femoral-popliteal segment (I stage) was performed with Pan Medical (PEKICO), OPTA PRO (Cordis) balloon catheters. In 41.10% of observations, balloon angioplasty of the femoral segment was continued with the placement of a stent - a self-expanding Smart ControL stent (Cordis), a self-expanding Carbostent stent (Flype), a self-expanding stent - Vascular stent (BARD) was used. Endovascular angioplasty of the arteries of the tibial segment (II stage) was performed using long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific). 76 intraluminal and 33 subintimal angioplasty were performed. When performing subintimal angioplasty, CompleteSE (Medtronic), Smart (Cordis) and CompleteSE (Medtronic) stents were used. In 40 patients, angioplasty was performed on two arteries of the leg, in 33 - on one of the tibial arteries.  At the first stage, an open reconstruction of the femoral-popliteal segment was performed - the formation of a femoral-popliteal autovenous shunt. In 20 (21.98%) observations, the proximal anastomosis was formed at the level of the bifurcation of the thoracic cavity during simultaneous deep fundoplasty. In 36 (39.51%) observations, the distal anastomosis of the autovenous shunt was formed at the level of the PCA by the end-to-end type. A 6F Check-Flo Performer (USA), Balton (EU) introducer was used to ensure the change of the balloon catheter. Long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific) were used, CompleteSE stents (Medtronic) – 23 cases, Smart (Cordis) – 24 observations. Conclusions. The early postoperative period of endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed is complicated by thrombosis of the popliteal-tibial segment in 15.9% of observations. Thrombosis of the popliteal segment is detected 2.7 times more often after endovascular angioplasty of one of the tibial arteries during endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed than during endovascular angioplasty of two tibial arteries. The effectiveness of the use of rheological thrombus extraction by the Angiojet system in the surgical treatment of postoperative thrombosis of the popliteal segment, which is formed in 15.9% of observations after endovascular revascularization of a stenotic-occlusive lesion of the femoral-distal arterial bed, is equal to 84.6%.