Rationale for performing distal hybrid reconstruction of the lower leg arteries depending on the degree of atherocalcinosis

Objective of the study. To determine the indications for distal hybrid reconstruction of the lower leg arteries based on the severity of atherocalcinosis in the lower leg arteries.

Material and methods. A prospective controlled non-randomized study involved 28 patients suffering from critical limb ischemia (CLI) who underwent hybrid arterial reconstruction at the vascular surgery department of CCH No. 29. All patients were divided into two groups. The first group (n = 14) consisted of patients who underwent restoration of the main blood flow at the level of the iliac-femoral arterial segment using a hybrid method. The control group (second group, n = 14) included patients who underwent simultaneous proximal and distal hybrid surgery, ensuring main blood flow through the “key” artery of the lower leg. Intraoperatively, all patients underwent intravascular laser photoluminescence spectroscopy using an authorial method. The plaques obtained from endarterectomy were subjected to mass spectrometry to determine their calcium content. Subsequently, the correlation between the intensity of calcium luminescence in the plaques, its concentration, and postoperative outcomes was assessed. Statistical analysis was performed using SPSS Statistics 17.0 software.

Results. A strong positive correlation was found between the amplitude of luminescence at a frequency of 380 nm and the quantitative calcium content in the plaque structure determined by mass spectrometry (r = 0.85; p < 0.001). In the second group, revascularization in the “key” artery could not be performed in 2 patients due to severe atherocalcinosis. In these patients, luminescence intensity was measured at 4.01 ± 0.11 × 10⁵. No thrombotic complications were recorded in the first group, while three cases were observed in the second group, with an average signal intensity of 2.18 ± 0.11 × 10⁵ photons, which significantly differed from both technically unsuccessful revascularization cases in the lower leg arteries (p < 0.05) and from cases with an uncomplicated postoperative period in this group (p < 0.001). In the early postoperative period, no bleeding or formation of perivascular hematomas were observed in either group. When assessing the average length of hospital stay and intraoperative blood loss, these parameters were comparable between groups.

Conclusion. The method of intraoperative luminescent spectroscopy is an effective way to determine the feasibility of distal hybrid reconstruction in the absence of hemodynamically significant lesions of the profunda femoris artery.

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