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Khirurgii

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Year 2018 Vol. 26 No 5

GENERAL & SPECIAL SURGERY

O.F. SOVTUS, R.V. SABADOSH

USE OF ENDOVASCULAR AND COMBINED INTERVENTIONS IN OBLITERATING OCCLUSIVE-STENOTIC ARTERIAL DISEASES OF THE LOWER LIMBS

Ivano-Frankivsk National Medical University, Ivano-Frankivsk,
Ukraine

Objective. To improve the results of treatment in patients with lower limb artery occlusive-stenotic diseases, where open operations are impossible or involve a high risk, by using endovascular interventions.
Methods. 53 patients have been treated, they underwent endovascular revascularization of lower limb artery different segments (I group – aortoiliac with or without femoropopliteal; IIÀ – femoropopliteal; IIB – femoropopliteal and infrapopliteal; III – infrapopliteal) with/without of the additional open operations on other segments. During the year a technical success of the procedures, the primary and secondary patency of intervention zones, the frequency of conservation and the degree of limb ischemia were assessed.
Results. The technical success was achieved in 94.3% of patients, 1-year secondary patency was achieved in 92.5%, the preservation of the lower limbs was achieved in 96.2%. In group I, where 60% of patients underwent hybrid operations (endovascular stage - on aortoiliac segment), a positive technical result was obtained in all the patients; stent thrombosis, necrotic processes, ischemia above grade IIA (Fontaine) were not observed during one year. Identical results were obtained in the IIA group. In the III group, which was based on patients with total occlusion of the lower leg and foot main arteries or total circular calcification of their post-occlusal segments, the technical success was 84.6%, the one-year primary patency was 76.9%, and limb salvage was 100%. In Group IIB these indicators were 91.7, 75.0 and 83.3%, respectively.
Conclusions. The careful application of endovascular interventions in stenosis and occlusions of the lower limbs arteries allows achieving technical success, primary and secondary patency of the revascularization zone and one-year limb salvage in 88.7-96.2% of patients. Endovascular treatment can be recommended as the method of choice in complete occlusion of the lower leg and foot main arteries, total circular calcification of their post-occlusal segments and for revascularization of aortoiliac segment in case of its combined lesions with the femoropopliteal segment at hybrid operations.

Keywords: peripheral arterial disease, critical limb ischemia, lower limb balloon angioplasty, stenting, hybrid procedures
p. 535-546 of the original issue
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Address for correspondence:
76018, Ukraine,
Ivano-Frankivsk, Galitskaya Str., 2,
Ivano-Frankivsk National Medical University,
Surgery Department of the Stomatological Faculty,
Tel. +38-097-933-52-94,
e-mail: r.sabadosh@gmail.com,
Rostyslav V. Sabadosh
Information about the authors:
Sovtus Oleg F., Post-Graduate Student of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0001-9125-7570
Sabadosh Rostislav V., MD, Professor of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0001-9770-5960
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