Year 2021 Vol. 29 No 2

EXCHANGE OF EXPERIENCE

S.V. MSHAR, V.N. ZASIMOVICH, V.A. ASANOVICH

HYBRID INTERVENTIONS IN EMERGENCY ANGIOSURGERY

Brest Regional Clinical Hospital, Brest, Republic of Belarus

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection.
Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine–Pokrovsky classification: 4 patients (25%) – IIb, 8 (25%) – III, 4 (25%) – IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2).
Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation – 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml.
Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

Keywords: hybrid intervention, multilevel atherosclerotic lesion, aortic dissection, endarterectomy, angioplasty, stenting
p. 250-256 of the original issue
References
  1. Movchan KN, Sukhov VK, Artiushin BS, Shloido EA, Shlomin VV, Levina AA. Vozmozhnosti ispol’zovaniia v regional’nykh sosudistykh tsentrakh endovaskuliarnykh metodik lecheniia patsientov, stradaiushchikh kriticheskoi ishemiei nizhnikh konechnostei. Vestn Ros VMA [Elektronnyi resurs]. 2018 [data obrashcheniia: 2020 Mart 30];37(4):164-68. doi: 10.17816/brmma12338 (In Russ.)
  2. Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, Holt PJ. Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011 Oct;28(10):1144-53. doi: 10.1111/j.1464-5491.2011.03279.x
  3. Temrezov MB, Kovalenko ÊI, Bulgarov RS, Bakhmetev A.S, Temvezov TK, Botashev RN . The hybrid surgical interventions in patients with critical ischemia of lower extremities. RMZh. 2017;23(5):233-236. doi: 10.18821/0869-2106-2017-23-5-233-236 (In Russ.)
  4. Koidan AA, Batalin IV, Vavilov VN, Kaputin MY, Atmadzas AV, Atmadzas KA, Kuryanov PS, Gorin AS. Comparative results of different methods of arterial reconstruction in the patients with critical stenosis of the femoral-popliteal-tibial segment. Regional blood circulation and microcirculation. 2017;16(3):41-48. doi: 10.24884/1682-6655-2017-16-3-41-48 (In Russ.)
  5. Mukhammadieva KS, Gaibov AL, Baratov AK, Kalmykov EL, Nematzoda O, Rakhmonov DA. Place and value of endovascular and hybrid technologies in treatment of lower extremity peripheral artery disease. Vestn Avitsenny. 2018;20(1):103-12. doi: 10.25005/2074-0581-2018-20-1-103-112 (In Russ.)
  6. Schepens MAAM. Type B aortic dissection: new perspectives. J Vis Surg. 2018 Apr 23;4:75. doi: 10.21037/jovs.2018.03.16. eCollection 2018.
  7. Cannavale A, Santoni M, Fanelli F, O’Sullivan G. Aortic Dissection: Novel Surgical Hybrid Procedures. Interv Cardiol. 2017 May;12(1):56-60. doi: 10.15420/icr.2016:16:3
  8. Narayan P, Potdar Sh, Choudhury ShR, Saha A. Hybrid approach for management of type B dissection involving the aortic arch. Kardiochir Torakochirurgia Pol. 2019 Mar;16(1):42-43. Published online 2019 Apr 4. doi: 10.5114/kitp.2019.83945
  9. Puzdryak PD, Shlomin VV, Shloido EA, Ivanov MA, Didenko YuP, Kasyanov IV, Bondarenko PB, Grebenkina NYu, Rakhmatillaev T. Hybrid surgical treatment of a multilevel lesion of lower-limb arteries. Angiologiia i Sosudistaia Khirurgiia. 2018;24(1):80-88. https://gmpb2.ru/images/sosudistoy/ doklady/doklad1.pdf (In Russ.)
  10. Puzdriak PD, Shlomin VV, Bondarenko PB, Ivanov MA, Iurtaev EA, Didenko IuP, Grebenkina NIu, Kas’ianov IV, Gusinskii AV, Rakhmatillaev TB, Samko KV. Comparison of the results of hybrid and open surgical treatment of multilevel arterial disease of lower extremities. . Kardiologiia i Serdechno-Sosudistaia Khirurgiia. 2019;12(3):227-34. doi: 10.17116/kardio201912031227(In Russ.)
Address for correspondence:
224027, Republic of Belarus,
Brest, st. Meditsinskaia, 7,
Brest Regional Clinical Hospital,
Angiography Room,
tel .: +375 162 27-22-12,
e-mail: sergei.mshar@gmail.com,
Mshar Sergey V.
Information about the authors:
Mshar Searhei V. Physician, X-ray Endovascular Surgeon, Angiography Office, Brest Regional Clinical Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0002-6972-3915
Zasimovich Vladimir N., Head of the Department of Vascular Surgery, Brest Regional Clinical Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0002-0759-4628
Asanovich Valentin A. Head of the Angiographic Office, Brest Regional Clinical Hospital, Brest,
Republic of Belarus.
http://orcid.org/0000-0002-4124-0655
Contacts | ©Vitebsk State Medical University, 2007-2023