The effectiveness of different methods for the hybrid reconstruction of lower limbs arteries

Objective of the study: To improve the outcomes of hybrid reconstructions in patients with multifocal atherosclerotic lesions of the lower limb vessels.

Material and methods. The study involved 87 individuals who underwent hybrid reconstructions of the lower limb arteries. All hybrid interventions began with open reconstruction of the femoral arteries. Patients were divided into three groups based on the technique used for transitioning between stages of the intervention and performing endovascular revascularization: in the first group, the introducer was placed proximally through a partially sutured patch and distally via puncture of the sutured patch; in the second group, the endovascular stage of the operation was performed by introducing the introducer into one of the branches of the common femoral artery; in the third group, a bifurcated synthetic patch was used for synchronous positioning of the introducers both proximally and distally. Intraoperatively and in the early postoperative period, blood loss, presence and causes of complications, number of reoperations, and length of hospital stay were assessed. Postoperative management included monitoring the functional status of the limb by measuring the ankle-brachial index, ultrasound dopplerography, and laboratory tests at discharge, as well as at 1, 3, and 6 months after surgery. The average follow-up period for patients in the late postoperative period was 6.8 ± 1.1 months.

Results. Technical success was observed in 32 (91.4%) patients in the first group, 20 (90.9%) in the second group, and 29 (96.7%) in the third group. Intraoperatively, two patients in the first group experienced complications that required additional manipulations. In two cases in the second group, arterial wall perforation occurred during introducer rotation. No early intraoperative complications were noted in the third group. In the early postoperative period, four patients in the first group and two patients in the second group developed acute thrombotic complications. No early thrombotic complications were observed in the third group. In the distant postoperative period, primary arterial patency rates were 94.2% in the fi rst group, 95.5% in the second group, and 100% in the third group.

Conclusion. The technique of hybrid reconstruction with simultaneous endovascular revascularization of proximal and distal segments of the arterial basin of the lower limb is effective in both early and distant medium-term postoperative periods.

1. Baars E.C., Emmelot C.H., Geertzen J.H., Rommers G.M. Onderbeenamputatie wegens kritieke ischemie: morbiditeit, sterfte en mogelijkheden tot revalidatie [Lower leg amputation due to critical limb ischaemia: morbidity, mortality and rehabilitation potential]. Ned. Tijdschr. Geneeskd. 2007;151(49):2751–2752.

2. Abou-Zamzam A.M.Jr, Gomez N.R., Molkara A., Banta J.E., Teruya T.H., Killeen J.D., Bianchi C. A prospective analysis of critical limb ischemia: factors leading to major primary amputation versus revascularization. Ann. Vasc. Surg. 2007;21(4):458–463. DOI: 10.1016/j.avsg.2006.12.006

3. Fistal E.Ya., Baziyan-Kuhto N.K., Fistal N.N., Kuhto A.P., Ivanenko A.A., Gryaduschaya V.V., Belkova V.A., Serebryakova Yu.R. Surgical treatment of patients with critical ischemia lower extremities with ulcerative-necrotic lesions. Vestnik neotlozhnoj i vosstanovitel’noj hirurgii. 2021;6(4):159–169. (In Russian)].

4. Kosenkov A.N., Vinokurov I.A., Kiseleva A.K. Treatment of critical lower limb ischemia followed by ulcerativenecrotic lesions. Kard. i serd.-sosud. khir. 2019;12(4):302–307. (In Russian)]. DOI: 10.17116/kardio201912041302

5. Belov Yu.V., Vinokurov I.A. The concept of surgical treatment of critical limb ischemia. Kard. i serd.-sosud. khir. 2015;8(5):9–13. (In Russian)]. DOI: 10.17116/kardio2015859-13

6. Gavrilenko A.V., Kochetkov V.A., Kravchenko A.A. Hybrid operations in chronic lower limb ischemia. Thoracic and cardiovascular surgery. 2021;63(5):413–418. (In Russian)]. DOI: 10.24022/0236-2791-2021-63-5-413-418

7. Puzdriak P.D., Shlomin V.V., Bondarenko P.B., Ivanov M.A., Yurtaev E.A., Didenko Yu.P., Grebenkina N.Yu., Kasyanov I.V., Gusinskiy A.V., Rakhmatillaev T.B., Samko K.V. Comparison of the results of hybrid and open surgical treatment of multilevel arterial disease of lower extremities. Kard. i serd.-sosud. khir. 2019;12(3):227–234. (In Russian)]. DOI: 10.17116/kardio201912031227

8. Vachev A.N., Sukhorukov V.V., Dmitriev O.V. Krugomov A.V. Sequence of stages of hybrid operations in patients with Leriche syndrome and critical limb ischaemia. Angiology and Vascular Surgery. 2016;22(1):159–164. (In Russian)].

9. Gavri lenko A.V., Kravchenko A.A., Kotov A.E., Kirichenko V.V. Hybrid reconstructions in patients with chronic lower limb ischemia and multilevel arterial lesion. Angiology and vascular surgery. The journal named after Academician A.V. Pokrovsky. 2018;24(3):183– 188. (In Russian)].

10. Glushkov N.I., Ivanov M.A., Artemova A.S. Results of various revascularization methods in patients with critical ischemia of lower limbs due to peripheral atherosclerosis. Cardiology and cardiovascular surgery. 2017;10(1):56–62. (In Russian)]. DOI: 10.17116/kardio201710350-56

11. Chernyavskiy M.A., Artyushin B.S., Chernov A.V., Chernova D.V., Zherdev N.N., Kudaev Yu.A., Chuikova I.O. A clinical case of hybrid treatment of a patient with multilevel arterial occlusive disease in lower limb arteries. Circulation Pathology and Cardiac Surgery. 2018;22(4):103–110. (In Russian)]. DOI: 10.21688/1681-3472-2018-4-103-110

12. Temrezov M.B., Kovalenko V.I., Temerezov T.K., Bakhmetev A.S., Loyko V.S., Rudakov M.O. Hybrid surgery in treatment of patients with obliterating atherosclerosis of lower extremities. Translational Medicine. 2020;7(1):33–38. (In Russian)]. DOI: 10.18705/2311-4495-2020-7-1-33-38

13. Zavatta M., Mell M.W. A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliacfemoral occlusive disease. J. Vasc. Surg. 2018;67(1):199–205. DOI: 10.1016/j.jvs.2017.06.098

14. Rusin V.I., Korsak V.V., Popovich Ja.M., Rusin V.V. The place of hybrid surgery in the treatment of critical ischemia of the lower extremities. Novosti hirurgii. 2014;22(2):244–251(In Russian)]. DOI: 10.18484/23050047.2014.2.244