MULTI-LEVEL OCCLUSIVE-STENOTIC LESIONS OF THE MAIN ARTERIES OF THE INFRARENAL AORTA IN PATIENTS WITH ATHEROSCLEROSIS: ANALYSIS OF TREATMENT AND COMPLICATIONS

Abstract

Resume. The Aim. To analyze the effectiveness of surgical treatment and postoperative complications in patients with multilevel occlusive-stenotic lesions of the main arteries (MOSLMA) of the infrarenal aorta.
 Materials and methods. The results of treatment and complications in 51 patients with (MOSLMA) of lower extremities, as a result of obliterating atherosclerosis, were analyzed. Of these, 42 (82.4 %) had two and 9 (17.6 %) three-level lesions. A total of 7 balloon angioplasties and 13 stentings were performed for two and three level lesions in which the iliac arterial segment was affected. Only balloon angioplasty was used for revascularization of the infrainguinal segments.
 Results and discussion. In general, regression of ischemia was achieved in 48 (94 %) patients. Of the complications in the early postoperative period, retrombosis was diagnosed in 6 patients. In 3 of them, the limb was saved by thrombolytic therapy and angioplasty. The other 3 patients underwent limb amputation. Mortality in the early postoperative period was 3.9 % (2 patients died as a result of myocardial infarction). An example of successful treatment of a patient with (MOSLMA) and previously stented superficial femoral artery is given.
 Conclusions. Patients with (MOSLMA) are a complex category with predominantly aggravated comorbidity. The optimal method of revascularization is endovascular. Arterial puncture under ultrasound guidance helps to reduce complications such as hematomas and false aneurysms. The introduction of a clear algorithm based on preoperative assessment of anatomical and hemodynamic lesions of the arteries, taking into account the severity of the patient’s condition, can give good treatment results.