Long-Term Results of Reconstructive and Recovery Operations About Chronic Critical Ischemia of the Lower Extremities

Abstract

Introduction. The prevalence of obliterating diseases of the lower extremities is almost 10 – 13 % of population. This indicator continues to grow steadily and reaches 30 % of the population due to the aging population, smoking and diabetes, and constitutes a significant socio-economic problem. Aim. To evaluate the long-term results of surgical treatment of occlusive-stenotic lesions of the arteries of the lower extremities with condition of chronic critical ischemia. Materials and methods. A retrospective analysis of the long-term postoperative period was conducted in 310 patients with critical ischemia in obliterating atherosclerosis of the lower extremities. Рatients were divided into 3 groups depending on the surgical intervention performed: group I – 127 (41.0 %) patients who underwent open reconstructive interventions with restoration of main blood flow; group II – 145 (46.8 %) patients who underwent various types of endarterectomy with artery plastic surgery; Group III – 38 (12.2 %) patients who underwent repeated reconstructive interventions. Results. The patency of the reconstruction zone, the preservation of a viable limb, and the presence of general complications associated with the multifocal nature of the atherosclerotic process during the 5 and 10 year follow-up period were evaluated in all groups. In the 1st group, the patency of the reconstruction zone was noted in 64.2 % and 47.6 % of patients, and the preservation of the functional limb was noted in 84.4 % and 61.9 % of cases during 5 and 10 years of observation, respectively. In the II group, the patency of the reconstruction zone was noted in 47.7 % and 19.5 %, respectively, preservation of the reproductive limb - in 74.3 % and 47.2 % of cases, respectively. In the III group, the patency of the reconstruction zone was found in 19.4 % and 14.3 %, respectively, preservation of the reproductive limb - in 35.5 % and 28.6 % of cases, respectively. Conclusions. Surgical treatment of chronic critical ischemia of the lower extremities in the remote postoperative period allows to preserve the functional limb after shunt operations and endarterectomy in 61.9 % and 47.2 % of patients, respectively. The progressive course of obliterating atherosclerosis causes a high frequency of multifocal occlusive-stenotic lesions, which leads to an increase in the frequency of acute vascular events and high mortality in the distant postoperative period.