PREVENTIVE SURGICAL INTERVENTIONS AFTER VASCULAR RECONSTRUCTIONS FOR CHRONIC LOWER LIMBS ISCHEMIA

The aim of the study: to evaluate the results of repeated reconstructive interventions on the main arteries of the lower limbs. Materials and methods: Treatment outcomes in 43 patients were studied. Of them, the main group comprised 18 patients (Group 1) who underwent preventive vascular reconstructions. The control group included 25 patients who underwent repeated interventions for acute or chronic reocclusion of the reconstruction area. According to the degree of chronic ischemia, patients in the main group were distributed as follows: with 2A degree – 5 (27.7%), 2B degree - 12 (66.6%), 3 degree– 1 (5.55%). The 2nd Group included patients with chronic ischemia: with 2B degree – 8 (53.3%), with 3 degree – 5 (33.3%), with 4 degree – 2 (13.4%). In the 3rd group: with 2A degree of ischemia – 3 (30%), 2B – 5 (50%), 2C – 2 (20%). Results: Shunt reconstruction was performed most frequently – 23.8% and hybrid operations - 20.9%. Endovascular operations were performed in 16.3%, anastomotic aneurysm resection in 11.6%, repeated bypass in 16.3%, and revision and/or conservative therapy in 4.7%. The duration of surgical treatment, intraoperative blood loss, and the number of complications in the preventive intervention group were significantly less than in Groups 2 and 3 (p<0.05). There was no mortality in Group 1, in the 2nd Group there were 2 (13.3%) amputations and no mortality, in the 3d group there were 3 (30%) amputations and 1 (10%) death. Conclusions: 1. Prophylactic surgical interventions prevent the development of ischemia threatening limb loss. 2. Dynamic monitoring, including: routine examinations and the implementation of ultrasound with measurement of the shoulder-ankle index in the long term after primary vascular intervention, contributes to the early detection and prevention of vascular catastrophe. The group of patients with initial critical limb ischemia requires particularly close attention, due to the high risk of limb loss in case of reocclusion. 3. Performing preventive interventions is justified regardless of the degree of compensation of blood circulation in the limb.