A method for preventing complications in complex revascularization of the angiosomal artery of the tibia within the framework of distal hybrid reconstruction

Objective of the Study. To develop a method for distal hybrid reconstruction and postoperative management of patients with complex revascularization of the angiosomal artery of the tibia. Material and methods. The prospective study involved 20 individuals suffering from tandem stenotic-occlusive lesions of the common femoral artery and the arteries of the lower leg. Endovascular revascularization of distal segments was performed using a subintimal approach, which presented significant technical challenges due to the extent of occlusion and pronounced atherocalcinosis of the lower leg arteries in the patients. The first group (n = 10) consisted of patients who underwent distal femoral reconstruction with the installation of a port system for postoperative heparinization of the intervention area for 30 days, as proposed by us. The second group, the control group (n = 10), consisted of patients who underwent the intervention using the classical method. Clinical indicators of effectiveness during the early and late postoperative periods were assessed over 90 days. Results. The degree of intraoperative blood loss (Group 1 — 202.4 ± 20.5 ml, Group 2 — 230.8 ± 26.2 ml, p = 0.15) as well as the duration of the surgical intervention overall (Group 1 — 152.1 ± 10.1 min; Group 2 — 144.8 ± 17.1 min, p = 0.13) were comparable between the groups. Early postoperative complications such as bleeding, hematoma formation, and infiltrates at the site of angioplasty were not observed. A comparable increase in the postoperative ankle-brachial index and distance of pain-free walking was noted. When assessing indicators during the late postoperative period, it is important to note a significantly lower number of adverse events and an earlier onset in Group 1 (p < 0.05). Furthermore, two patients from Group 2 underwent major amputations, which did not occur in the study group with our proposed method of hybrid reconstruction. The frequency of recoil effects was comparable between the groups. The study of the dynamics of ulcerative-trophic defects showed that the number of necrosectomies using the port system did not significantly diff er from the control group, while the healing rate of the ulcerative defect after prophylactic heparinization courses was significantly higher compared to the standard distal hybrid operation method (p < 0.05). Conclusion. In situations involving distal hybrid reconstruction, where technical difficulties in revascularizing the lower leg arteries are objectively determined by the severity of their atherosclerotic lesions and a high likelihood of early recurrence of occlusion, the use of a port system with prophylactic courses of heparinization in the vascular reconstruction area yields good clinical results.

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