Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2016 Vol. 24 No 5

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.5.451   |  

V.V. BOIKO, V.A. PRASOL, K.V. MIASOIEDOV

APPLICATION OF HYDRAULIC DISOBLITERATION METHOD IN TREATMENT OF PATIENTS WITH LOWER LIMBS CRITICAL ISCHEMIA

Kharkov National Medical University,
Kharkov,
Ukraine

Objectives. To estimate the significance of hydraulic dissection of arteries in treatment of patients with chronic critical limb ischemia as a potential method of artery disobliteration.
Methods. 20 amputated specimens of the arteries isolated from the lower extremity in patients with critical limb ischemia were studied. Hydraulic dissection of the arterial wall, affected by atherosclerosis was performed to disobliterate its lumen. To perform this technique the isotonic fluid was injected sub-adventitially to separate obstructing substrate from the residual wall in the arterial lumen. After atherosclerotic plague separation the last one was extracted via the longitudinal arteriotomy.
Results. The hydraulic disobliteration was completed on the segments of femoral and popliteal arteries over 5±2,1 cm, this index made up 3±1,7 cm on the tibial arteries. In 17 cases the plague was completely separated from the wall and extracted via a arteriotomy orifice as a single conglomerate. At the same time the plague was extracted via the arteriotomy orifice sized 1,5±0,8 cm. Extracted substrate was an atherosclerotic plaque in conjunction with media portion, had a smooth surface and it became thinner in a site of natural reduction of the stenotic lesion. In 3 cases the mechanical endarterectomy was required to perform caused to the fragmentation of the obturating substrate to add the purposed method. Throughout the whole disobliterated site no intima fragments were not detected in macroscopical study of residual wall.
Conclusion. The technique of hydraulic endarterectomy allows to perform dissection of the arterial wall, thereby to separate obstructive substrate from the arterial wall and to extract it in sufficient volume as along the affected segment, as throughout the depth of the arterial wall lesions from the lumen. This technique involves no special equipment to introduce liquid agent into the subadventitial space.

Keywords: endarterectomy, arterial wall, plaques, critical ischemia, hydraulic dissection, atherosclerosis, disobliteration
p. 451-456 of the original issue
References
  1. Aho PS, Venermo M. Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg. 2012;101(2):107-13.
  2. Sheng N, Chiriano J, Teruya TH, Abou-Zamzam AM, Bianchi C. Evaluation of superficial femoral artery remote endarterectomy for treatment of critical limb ischemia in patients with limited autogenous conduit. Ann Vasc Surg. 2014 Jan;28(1):262.e1-7. doi: 10.1016/j.avsg.2013.01.023.
  3. Stanley JC, Veith F, Wakefield TW, eds. Current therapy in vascular and endovascular surgery. 5th ed. Saunders; 2014. 1040 p.
  4. Antoniou GA, Koutsias S, Antoniou SA, Giannoukas AD. Remote endarterectomy for long segment superficial femoral artery occlusive disease. A systematic review. Eur J Vasc Endovasc Surg. 2008 Sep;36(3):310-18. doi: 10.1016/j.ejvs.2008.04.005.
  5. Taylor RS. Gas endarterectomy. Techniques, applications, and initial results. Lancet. 1967 Aug 5;2(7510):281-83.
  6. Baron HC, Schwarz AW, Cabaluna W, Rodrigues RJ. Gas endarterectomy in the treatment of the ischemic lower extremity. Arch Surg. 1969 Jun;98(6):754-57
Address for correspondence:
61022, Ukraine, Kharkiv,
pr. Nauka, 4, Kharkiv National Medical University, department of surgery N1.
Tel: + 380950111141
E-mail: vonmiasoiedov@gmail.com Myasoedov Kirill Valerevich
Information about the authors:
Boiko V.V. MD, Professor, Head of department N1 of surgical diseases, Kharkov National Medical University.
Prasol V.A. MD, Professor of department N1 of surgical diseases, Kharkov National Medical University,
Miasoiedov K.V. Post-graduate student of department N1 of surgical diseases, Kharkov National Medical University.
Contacts | ©Vitebsk State Medical University, 2007