Hybrid reconstruction of the arteries of the lower extremities as a «surgery of choice» for multilevel atherosclerosis

The aim of the study was to determine the indications for hybrid operations on the arteries of the lower extremities using the APACHE II and SAPS II multiorgan insufficiency risk assessment scales.

Material and methods. 36 patients participated in the study, all study participants were divided into two groups: group 1 (n = 18) – patients who had a low risk of developing multiple organ failure (APACHE II from 0 to 15 points, SAPS II – from 0 to 7 points) and associated mortality (APACHE II – 10.8%, SAPS II – 11–12%). Study group 2 (n = 18) – patients who had an average risk of developing multiple organ failure (APACHE II – from 15 to 29 points, SAPS II – from 7 to 15 points) and associated mortality (APACHE II – 21.3%, SAPS II – 22–34%). There were 2 subgroups in these groups: subgroup A – patients who underwent hybrid interventions, subgroup B – patients who underwent multi-storey reconstructions. The groups were homogeneous in terms of age, gender, and the spectrum of concomitant pathology. The follow-up period for patients was 30 days.

Results. The duration of the operation in the study groups did not depend on the option of its implementation, as well as on the initial severity of the operated patients. In the study group with a low risk of developing multiple organ failure and death, no complications were detected in the subgroup with more traumatic multilevel arterial reconstruction, while after hybrid interventions, one case of postoperative thrombosis was recorded. In subgroup 1B, there were also significantly better indicators of limb revascularization (p < 0.05). In patients of subgroup 2B of the study, who scored an average number of points on the integral risk scales of multiple organ failure, a significantly higher number of thrombotic complications was noted, regardless of the affected segment. It is important to note that in the second group of the study, the indicators of limb revascularization were comparable between subgroups A and B. During the 30-day follow-up period from the moment of discharge: in the first group of the study, restenoses, repeated hospitalizations and operations, including amputations, were not detected. In the second group of the study, the number of thrombotic complications, post-discharge reocclusions, as well as related emergency vascular revisions was significantly higher in subgroup B (p < 0.05). 15 minutes after blood collection and addition of heparin to the drug, the area of deposited erythrocytes was significantly higher in patients of group 2 (5.45 ± 0.22 mm²) compared with the 1st group of the study (2.13 ± 0.16 mm²; p < 0.05). It is necessary to note a strong direct correlation between the luminescence amplitude at a frequency of 450 nm and the area of the «coin» columns of erythrocytes formed in the smear (r = 0.86; at p < 0.05).

Conclusion. According to the results of the study, a direct relationship was revealed between the degree of risk of developing multiple organ failure and mortality, assessed on the APACHE II and SAPS II scales, and the results of hybrid and multilevel vascular reconstructions on the arteries of the lower extremities. Assessment of local hemorheology using luminescent spectroscopy is an important method in predicting the results of vascular reconstruction on the arteries of the lower extremities.

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