Surgical treatment immediate results of lower limbs chronic critical ischemia in simmultaneous direct and indirect revascularization

Abstract

The aim: To assess the immediate results of autovenous femoral-tibial shunting in combination with rotary osteotrepanation of the tibia by studying changes in the transcutaneous ptO2 tension in the tibia and foot tissues depending on the revascularization of the tibial arteries. Materials and methods: We analyzed the treatment of 69 patients with obliterating atherosclerosis of the vessels of the lower extremities. According to the degree of ischemia of the lower extremities, the patients were distributed as follows: III A degree of ischemia - 20 (29%), III B - 28 (40.6%), IV - 21 (30.4%) patients. All patients had atherosclerotic lesions of the popliteal-tibial segment of the great arteries with preserved central blood flow in the aorto-iliac segment. Results: Occlusion of the anterior tibial artery was recorded significantly more often than the peroneal artery (72% and 42%, respectively, p = 0.05), but with the same frequency compared to the posterior tibial artery (68%, p = 0.61). The lesion of two or three arteries of the lower leg was recorded more often than occlusion of one (n = 51; 73.9% and n = 18; 26.1%). Occlusive-stenotic lesion of the popliteal artery was observed in 54 (78.2%) patients. The highest incidence of lesions of the tibial arteries was observed in the basin of the anterior tibial artery in 28 (40.6%) patients. Combined lesions of the anterior tibial artery and posterior tibial artery were diagnosed in 19 (27.5%) patients. Limited lesions of the posterior tibial artery were found in 15 (21.7%) patients. The combination of lesions of the posterior tibial artery and peroneal artery was diagnosed in 7 (10.2%) patients. Conclusions: 1. The patency of the femoral-tibial autovenous shunt during the year was 71%. High limb amputation was performed in 29% of patients. 2. According to CT data, the localization of trophic changes on the foot during critical ischemia of the lower extremities corresponds to the affected segment of the arterial angiosome, which supplies the corresponding area with blood. 3. After femoral-tibial autovenous bypass grafting, the highest levels of transcutaneous oxygen tension were observed in the basin of the posterior tibial artery and peroneal artery, and the lowest indicators of transcutaneous oxygen tension were observed in the basin of the anterior tibial artery. 4. During femoral-tibial autovenous shunting operations in combination with rotary osteotrepanation, the transcutaneous oxygen tension indices increased threefold in the angiosomal basin of the posterior tibial artery and peroneal artery, and twofold in the angiosomes of the dorsum of the foot and sole.