Reserve capacities

Types of reconstructive surgery

At high occlusion of the aorta, bilateral lesions of arteries, depending on the severity of the patient perform operations on aortobedrennogo bifurcation or bypass line to the axillary or subclavian-femoral bifurcation shunting. If the critical ischemia, there is only one side, then defeat the iliac and femoral artery in the contralateral limb performed a unilateral cross-iliac-femoral, axillary or subclavian-femoral bypass.

At the present stage reconstructive operations occupy a leading brand viagra position in treating these patients. The number of such operations is constantly increasing, significantly increasing their volume, which allows you to save the limb, even in severe forms of chronic arterial insufficiency. Resorption keloid scars occurring after surgery, the drug is effective Kontraktubeks that has fibrinolytic, antithrombotic, and keratolytic action.

Meanwhile, the implementation of a complete reconstruction is often at odds with a patient to postpone surgery. Operations in these cases should be minimal and the duration of trauma, since the vast majority of these patients have severe comorbidities, sharply restricting the functional reserve capacities of the organism [11]. Using the method of combined operations, including balloon angioplasty combined with open surgery under epidural or local anesthesia, significantly reduces the amount of intervention and to abandon the complex surgical reconstruction in several segments.

Clinical case

Patient Z., 68, was admitted complaining of aching pain in the right lower leg and foot at rest, intermittent claudication after 30 pm

Doppler ultrasound: a significant reduction in blood flow in the trunk of the right common femoral artery, collateral when the "no" means "yes" blood flow in the popliteal and tibial arteries.

Ankle-brachial index on the left 0.59, right 0.35.

Aortoarteriografiya: critical stenosis of the common iliac artery (GPA) on the right, the deep femoral artery stenosis (Gba) right; occlusion of both superficial femoral artery (PAP), segmental occlusion of the right popliteal artery within 5 cm (Fig. 1).

Fig. 1. Angiogram patient Z.:
and - OPA stenosis on the right;
b - right Gba stenosis, occlusion of both the PAP;
in - after balloon angioplasty (no area of stenosis of the right DVC).

Atherosclerotic arteries (medical history).

Associated diseases: coronary heart disease, atherosclerotic cardiosclerosis, angina, chronic bronchitis, pneumosclerosis, emphysema.

The first step performed balloon angioplasty on the right DVC, the second under epidural anesthesia on the right side plastic Gba (Fig. 2).

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