Патофізіологічно обґрунтована профілактика та лікування реперфузійно- реоксигенаційного синдрому при реваскуляризації нижніх кінцівок в умовах хронічної критичної ішемії

Abstract

Introduction. One of the causes of the adverse effects of reconstruction of the aorto-femoral-popliteal segment is the development of reperfusion-reoxygenative syndrome.The aim. Improve the results of reconstructive operations on the aorta and major arteries under conditions of chronic critical ischemia of the lower extremities.Materials and methods. The work includes 56 patients with obliterating lesions of the aorta and arteries of the lower extremities of II, IIIA, IIIB, IV stages chronic arterial insufficiency. For the prevention and treatment of the phenomena of no-reflow and reflow-paradox in the pre-operative period, a complex of proposed measures was implemented. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disturbances, indicators of ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. To obtain information on changes in capillary blood flow and arteriovenular blood flow, the method of laser doppler fluorometry was used.Results. By volume of revascularization patients are divided into two groups. Operative intervention in the 1st group of patients included single-stage aorto-bifermal bypass (14 observations) and one-sided aorto(ileo)-femoral bypass (8 observations). The second group included 34 patients who in addition to atherosclerotic occlusion aorto/ilia-femoral segment revealed stenotic-occlusive process femoral-popliteal segment. Dynamic ultrasound monitoring of hemodynamic femoral-popliteal segment postoperative patients II gr. revealed a decrease in peak systolic velocity and resistive index, which was an additional indication for reconstruction of the femoral-popliteal segment.Conclusions Pathophysiologically grounded preoperative prevention and treatment of reperfusion-reoxygenative syndrome in revascularisation of the lower extremities under conditions of chronic critical ischemia, make it possible to prevent the development of postoperative complications