Substantiation of the stages of interventions in patients with multifocal atherosclerosis with combined lesions of coronary arteries and lower extremity arteries

Abstract

Objective. To study the features of staged interventions in patients with combined lesions of coronary arteries and arteries of the lower extremities. Materials and Methods. The results of surgical treatment of 26 patients with combined lesions of coronary arteries and lower extremity arteries for the period from 2016 to 2023, the first stage of which was myocardial revascularization, were analyzed, and the data of 22 patients who underwent revascularization of the lower extremity arteries before 2016 were retrospectively analyzed. The operations were performed without cardiopulmonary bypass. Venous and arterial graphs were used. Results. The postoperative period was uneventful in 35 (73%) patients. Perioperative complications were assessed according to the presence of major adverse cardiovascular events. Among the complications in the intra­ and postoperative period, myocardial infarction was observed in 5 (23%) patients who underwent revascularization of the lower extremity arteries (p < 0.001), which was accompanied by longer mechanical ventilation and higher doses of vasopressor and inotropic support in the intensive care unit. Problems associated with increased lower extremity ischemia were noted in 5 (19%) patients who underwent myocardial revascularization as the first step (p < 0.005). Conclusions. In the case of combined lesions of the coronary arteries and arteries of the lower extremities, coronary artery bypass grafting should always be performed first. If coronary pathology is not corrected, the risk of perioperative myocardial infarction, fatal arrhythmia, and death increases.