Page 339 - Read Online

Page 2 of 8 Nikolay et al. Vessel Plus 2018;2:35 I http://dx.doi.org/10.20517/2574-1209.2018.45

INTRODUCTION
The comparative evaluation of the outcome after infrainguinal arterial disease (IAD) revascularization
[1]
demonstrates controversial results .

Bypass operations are the method of choice in the treatment of patients with IAD on the background
[2,3]
of critical ischemia of the lower extremities . However, open interventions for distal segment are not
always effective; there is a great deal of blood loss and the risk of infectious complications in comparison
[4,5]
with minimally invasive interventions (balloon angioplasty and stenting) . The latter are now becoming
[6]
increasingly common . Often endovascular interventions are used in the tibial artery reconstructions due to
[7]
the high risk of poor wound healing after open operations . But the use of endovascular technologies at the
level of the femoro-tibial segment is difficult with extensive stenotic and occlusive lesions, as well as arteries
[8]
with wall calcification .
The ascending spread of hybrid techniques has allowed the improvement of the results of surgical
interventions at both proximal and distal segments, including patients with multilevel lesions, since the
combined use of open and endovascular methods of revascularization allows to summarize the positive
[9]
sides of each technique and to reduce the number of possible complications due to minimal trauma .

Aim: to make a comparative assessment of the use of various reconstructive methods in the atherosclerotic
lesions of the femoro-tibial segment.

METHODS
Two hundred and fifty-three patients with atherosclerotic lesions of arteries below the inguinal ligament
were examined. According to the type of performed reconstruction, the patients were divided into 3 groups:
the first group consisted of 98 patients who underwent open operative (OO) interventions; the second group
consisted of 116 people who underwent endovascular procedures (EP): balloon angioplasty of femoral,
popliteal or tibial arteries; the third group consisted of 39 patients, who had undergone hybrid surgery
techniques (HS).

The primary endpoint was development of thrombosis of the operated segment, bleeding and surgical site
infection, the need for re-interventions and amputations within 30 days after primary revascularization.

All patients underwent carbohydrate and lipid metabolism analysis: fasting glucose level, a day glucose
fluctuations; for assessing of lipid metabolism the level of total cholesterol and its fractions were analyzed, as
well as the atherogenicity coefficient value. The measurement of blood pressure in the perioperative period
was carried out by direct and indirect methods.

Diabetes was diagnosed in accordance with the WHO recommendations. The evaluation of hypertension was
carried out according to the WHO and the International Society for Hypertension classifications. The analysis
of chronic heart failure (CHF) was carried out according to the New York Heart Association classification.
All patients underwent a measurement of the ankle-brachial index before and after surgery; duplex scanning,
CT angiography to determine the features of atherosclerotic lesion of the lower extremities arteries.

The frequency of patient concomitant disease is presented in Table 1.

Variants of the performed operations are presented in Table 2.

The evaluation of the operation time duration, blood loss volume, length of stay in the intensive care unit, in-
hospital stay days, fluctuations in blood pressure and blood glucose level. In the postoperative period the