Sukovatykh B S, Belikov L N, Sukovatykh M B, Sidorov D V, Inarkhov M A, Inokhodova E B
Kursk State Medical University, Kursk, Russia.
Municipal Clinical Hospital of Emergency Medical Care, Kursk, Russia.
Angiol Sosud Khir. 2016;22(4):137-143.
The objective of the study was to improve therapeutic outcomes in patients presenting with lower limb critical ischaemia by means of optimizing the technique of femoropopliteal bypass grafting. The authors analysed the results of comprehensive examination and treatment of a total of 90 patients presenting with critical lower limb ischaemia on the background of atherosclerotic lesions of arteries of the femoropopliteal and crural segments. Depending on the technology of performing femoropopliteal bypass grafting, the patients were subdivided into three groups each consisting of 30 subjects. The groups were comparable by gender, age, concomitant diseases, degree of damage to arteries of the femoro-popliteal-crural segment, and the state of the distal vascular channel. Group One patients underwent conventional autovenous bypass grafting with a reversed great saphenous vein. Group Two patients endured surgery according to the "in situ" technique. Group Three patients were subjected to an original technology of bypass grafting using a free autovenous graft with destroyed valves without reversion of the vein. It was demonstrated that the use of a free autovenous transplant with destroyed valves increased the volumetric blood flow through the shunt in the remote postoperative period 2.4-fold as compared with the reversed vein and 1.7-fold as compared with the "in situ" autovein. The proposed technique of femoropopliteal bypass grafting made it possible in the immediate postoperative period to decrease the rate of early postoperative complications by 23.4% as compared with the option of using the reversed vein and by 13.3% as compared with the "in situ" technique, as well as to lower the incidence rate of late shunt thromboses by 40 and 13.3%, respectively, and the number of limb amputations by 30 and 6.7%, respectively. The use of a free autovenous graft with destroyed valves is pathogenetically justified and makes it possible to optimize the results of treatment of patients.
本研究的目的是通过优化股腘动脉搭桥术技术，改善下肢严重缺血患者的治疗效果。作者分析了总共90例因股腘和小腿段动脉粥样硬化病变而出现下肢严重缺血患者的综合检查和治疗结果。根据股腘动脉搭桥术的实施技术，将患者分为三组，每组30例。各组在性别、年龄、伴随疾病、股腘-小腿段动脉损伤程度以及远端血管通道状况方面具有可比性。第一组患者接受了使用大隐静脉倒置的传统自体静脉搭桥术。第二组患者按照“原位”技术接受手术。第三组患者接受了一种使用无瓣膜破坏的游离自体静脉移植物的原始搭桥术技术，且静脉未倒置。结果表明，与静脉倒置相比，使用无瓣膜破坏的游离自体静脉移植物在术后远期可使分流处的血流量增加2.4倍，与“原位”自体静脉相比增加1.7倍。所提出的股腘动脉搭桥术技术在术后即刻可使早期术后并发症发生率与使用静脉倒置相比降低23.4%，与“原位”技术相比降低13.3%，同时使晚期分流血栓形成发生率分别降低40%和13.3%，肢体截肢数量分别降低30%和6.7%。使用无瓣膜破坏的游离自体静脉移植物在发病机制上是合理的，并且能够优化患者的治疗效果。
