A method for performing distal hybrid reconstruction using a femoral-popliteal shunt with an introducer port

The objective of the study is to develop, implement, and evaluate the eff ectiveness of a method for distal hybrid reconstruction using a shunt with a port system for performing endovascular revascularization. Material and methods. In a prospective controlled non-randomized study, 24 individuals suff ering from femoral-popliteal occlusion and stenotic-occlusive lesions of the lower leg arteries participated. The fi rst group (n = 12) consisted of patients who underwent femoral-popliteal bypass surgery above or below the knee joint gap in combination with balloon angioplasty of the lower leg arteries according to our proposed method, which involved modeling a special port system on the shunt for the installation of an introducer. The second control group (n = 12) included patients in whom the described interventions were performed using classical methods. The groups were comparable in terms of age, sex, and spectrum of comorbidities. For statistical data processing in comparing the study groups, SPSS Statistics 17.0 software was used. Results. No early postoperative complications were noted in the fi rst group. In the second group, two patients experienced postoperative bleeding associated with the dissection of synthetic graft tissue at the site of defect closure. The revascularization indicators of the limb at the time of discharge from the hospital were comparable between the groups. Additionally, there were no signifi cant diff erences in the healing rate of ulcerative defects on the foot or in the need for necrosectomies prior to discharge. Within one month after surgery, one patient from the second group was readmitted with a clinical and instrumental picture of thrombosis of the femoral-popliteal shunt, which was due to intraoperative compression of the atheroscleroticly aff ected popliteal artery after control angiography. No complications were noted in the fi rst group during this period. In terms of key parameters of the late postoperative period (number of reoperations, recurrence of critical ischemia, amputations, mortality), both groups were comparable during the six-month follow-up. Conclusion. Performing femoral-popliteal bypass surgery using a port system for conducting the endovascular stage of revascularization on the lower leg arteries as part of a hybrid operation helps minimize early postoperative complications, and therefore can be used in distal hybrid reconstructions.

1. Belov Iu.V., Vinokurov I.A. The concept of surgical treatment of critical limb ischemia. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2015;8(5):9–13. (In Russian).

2. Katelnitskiy I.I., Sasina E.V., Polyak M.I. Clinical results of angioplasty depending on the number of restore of crural arteries and blood fl ow in the arterial arch of the foot in patients with critical limb ischemia. Kuban Scientifi c Medical Bulletin. 2017;(3):51–57. (In Russian). DOI: 10.25207/1608-6228-2017-24-3-51-57

3. Katelnitskiy I.I., Sasina E.V., Polyak M.I., Trandofi lov A.M. Сomparative evaluation of the clinical results of transluminal balloon angioplasty depending on the recovery of crural arteries on the basis of «angiosomes» theory. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2017;12(3):19–23. (In Russian).

4. Bokeria L.A., Arakelyan V.S., Papitashvili V.G., Tsurtsumiya Sh.Sh. Long-term results of proximal and distal reconstructions in patients with lower limb arteries diff use lesions and diabetes mellitus. RUDN Journal of Medicine. 2021;25(4):271–281. (In Russian). DOI: 10.22363/2313-0245-2021-25-4-271-281

5. Gavrilenko A.V., Kochetkov V.A., Kravchenko A.A. Hybrid operations in chronic lower limb ischemia. Russian Journal of Thoracicand Cardiovascular Surgery. 2021;63(5):413–8. (In Russian). DOI: 10.24022/0236-2791-2021-63-5-413-418

6. Kazakov Yu.I., Lukin I.B., Vekilov P.G., Strakhov M.A. The choice of the method of reconstruction of the infrainguinal arterial segment in patients with chronic critical ischemia of the lower extremities. Cardiology and cardiovascular surgery. 2014;7(6):42– 48. (In Russian).

7. Gavrilenko A.V., Kravchenko A.A., Kotov A.E., Kirichenko V.V. Hybrid reconstructions in patients with lower limb chronic ischaemia and multilevel arterial lesions. Angiol Sosud Khir. 2018;24(3):183–187. (In Russian).

8. Matmurotov K.J., Irnazarov A.A., Ruzmetov P.Yu., Ruzmetov N.A. Leg amputations: a diff erentiated approach to performance depending on the lesion of the arterial basin. Vestnik ekstrennoj mediciny. 2022;15(5),18–25. (In Russian). DOI: 10.54185/TBEM/vol15_iss5/a3

9. Voloshin A.N. Trofi cheskie izmeneniya na stope v zavisimosti ot porazheniya arterij nizhnih konechnostej. Mir mediciny i biologii. 2015;11(4–1(53)):18–21. (In Russian).

10. Puzdryak P.D., Shlomin V.V., Bondarenko P.D. etc. Comparison of the results of hybrid and open surgical treatment of multilevel lesion of the arteries of the lower extremities. Cardiology and cardiovascular surgery. 2019;3(12):227–234. (In Russian). DOI: 10.17116/kardio201912031227

11. Kosenkov A.N., Vinokurov I.A., Kiseleva A.K. Treatment of critical ischemia of the lower extremities with ulcerative necrotic lesions. Cardiology and cardiovascular surgery. 2019;12(4):302–307.(In Russian). DOI: 10.17116/kardio201912041302

12. Zakiryaev A.B., Vinogradov R.A., Matu sevich V.V., Butaev S.R., Sukhoruchkin P.V., Baryshev A.G., Porkhanov V.A. Femoral-popliteal bypass surgery: from the origins to the present day. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov. 2021;16(3):57–60. (In Russian).