Hybrid interventions on distal sections of the main arteries in extended chronic occlusions of the superficial femoral artery in patients with critical limb ischemia

А. А. Кучай; А. Н. Липин

doi:10.34687/2219-8202.JAD.2024.02.0004

Авторы

А. А. Кучай Городской центр спасения конечностей, СПБ ГУЗ ГБ № 14
А. Н. Липин ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФ

DOI:

https://doi.org/10.34687/2219-8202.JAD.2024.02.0004

Аннотация

Абстракт
Резюме. Более половины пациентов с критической ишемией нижней конечностей (КИНК)
имеют окклюзионные поражения поверхностной бедренной артерии (ПБА), которые пред-
ставляют собой полные протяженные хронические окклюзии и обычно сопровождаются
диффузными поражениями артерий голени. Мы ретроспективно оценили результаты гибридных
вмешательств у пациентов с КИНК, имевших протяженные окклюзии ПБА в со-
четании с диффузным поражением артерий голени, поступивших в центр спасения конеч-
ностей ГБ№14 Санкт-Петербурга.
Цель. Улучшить результаты реваскуляризации нижней конечности у пациентов с протя-
женными окклюзиями ПБА в сочетании с поражением артерий оттока.
Материалы и методы. Гибридные сосудистые операции выполнены 40 пациентам (жен-
щин – 10 [25%], мужчин – 30 [75%]; возраст – 45-88 лет, средний возраст – 69,5 года). Всем
выполнена операция по поводу критической ишемии одной нижней конечности (стадия
IV по А.В. Покровскому).
Результаты. Показатель 30-дневной летальности и несостоятельности венозного трансплан-
тата у оперированных больных составил 2,5% против 4,3% (p >0,05) и 5% против 13% (p <0,05)
после гибридного и тибиального шунтирования соответственно. Через 1 год первичная про-
ходимость шунтов и выживаемость без ампутации составили 77,7% (95% ДИ: 61,7–93,7)
vs 57,1% (95% ДИ:42,9–71,3) и 82,1% (95% ДИ: 66,8–97,4) vs 69,6% (95% ДИ: 56,1–83,1) после
гибридного вмешательства и тибиального шунтирования соответственно (p >0,05).
Заключение. По сравнению с бедренно-тибиальным шунтированием (БТШ) гибридное
вмешательство, состоящее из шунтирования подколенной артерии и последующей ангио-
пластики артерий голени, снизило частоту ранних осложнений без какого-либо негатив-
ного влияния на отдаленные результаты у пациентов с КИНК, протяженной окклюзией
ПБА и диффузным поражением артерий голени.

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Библиографические ссылки

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