Етапність хірургічних втручань у хворих із поєднаним атеросклеротичним ураженням екстракраніальних артерій та термінального відділу аорти й артерій нижніх кінцівок

Abstract

Introduction. According to literature, a combination of atherosclerotic lesions of the extracranial arteries, the terminal portion of the abdominal aorta and the lower extremity vessels occurs in 50-85% of patients.The aim of the study was to analyze the results of surgical treatment of patients with a combination of atherosclerotic lesions of the extracranial arteries, the terminal portion of the abdominal aorta and the main arteries of the lower extremities and to substantiate a differentiated surgical tactics of phasing arterial reconstructions.Materials and methods. There were evaluated the results of surgical treatment of 65 patients with a combination of atherosclerotic lesions of the extracranial arteries and other vascular territories.Results and discussion. In 7 patients with symptomatic ICA stenosis > 50% and 4 patients with asymptomatic ICA stenosis greater than 70% in case of contralateral ICA occlusion, carotid endarterectomy was performed first followed by the revascularization of the lower extremity vessels. In 7 patients with hemodynamically significant stenosis of the aortic arch branches, endovascular stenting was used. In the early postoperative period, acute cerebrovascular disease was observed in 2 (3.1%) patients; 1 (1.5%) patient died.Conclusions. In patients with symptomatic ICA stenosis >50% and hemodynamically significant ICA stenosis greater than 70% in case of contralateral ICA occlusion, it is recommended to start with carotid endarterectomy. In patients with critical limb ischemia and asymptomatic extracranial lesions, it is recommended to start with lower extremity revascularization.