[REVASCULARIZATION OF COMBINED OCCLUSION OF EXTRACRANIAL ARTERIES AND AORTO-ILEUM-FEMORAL ARTERIAL ROUTE IN CONDITIONS OF RISK OF DEVELOPMENT OF REPERFUSION-REOXYGENATION SYNDROME].

Objective - to increase the safety of revascularization in combined atherosclerotic occlusion of extracranial arteries, terminal aorta and the main arteries of the lower extremities in conditions of risk of reperfusion-reoxygenation syndrome. 87 patients with associated lesion of extracranial arteries and aorto-ileum-femoral segment were examined and treated surgically. In 64 patients various variants of atherosclerotic occlusion of the aorto-femoral segment were diagnosed, in 44 of which a stenotic occlusal process of the femur-popliteal segment was established. In 31 (35.6%) patients, the occlusive-stenotic process of extracranial arteries was diagnosed. In order to prevent and treat patients with a risk of developing reperfusion-reoxygenation syndrome, preoperative preparation consisted of: elimination of vasoconstriction, reduction of neutrophil activity and level of systemic inflammatory response, increase of endothelium resistance, normalization of microvascular permeability, increase in pro-oxidant-antioxidant equilibrium activity. In 25 patients, one-stage surgery was performed on the extracranial arteries and the aorta-ileum-femoral segment. At the first stage carotid endarterectomy was performed. At the second stage - the revascularization of the aorta-ileum-femoral zone. All patients underwent aorto-bifemoral (64 observations) and one-sided ileo-femoral (16 cases) alloscout. On the third day after the aortic / ileum-femoral reconstruction surgery 25 patients underwent a hip-distal reconstruction. Systemic complex prophylaxis and terminal treatment of patients at risk of developing reperfusion-reoxygenation syndrome can prevent the development of deepening of ischemia of the lower extremity, renal failure and other severe reperfusion complications.

[ENDOTHELIAL DYSFUNCTION AND MICROSCIRCULATION FEATURES IN PATIENTS WITH HIGH RISK OF DEVELOPMENT OF REPERFUSION SYNDROME IN CONDITIONS OF RECONSTRUCTION ARTERIAL OPERATIONS].

Aim - to study the state of the microcirculatory bed and the endothelial system in patients at risk of developing reperfusion syndrome and suggest methods for their correction. The work included 29 patients with obliterating diseases of the abdominal aorta and lower limb arteries with a high risk of developing reperfusion complications. Two groups of patients were identified. Group I - 8 patients, preoperative preparation include the generally accepted approaches. Group II - 21 patients whose preoperative preparation included, in addition to preparations for improving rheological blood conditions, prolonged epidural anesthesia, intravenous injection of hydroxyethylstarches, korvetin and alprostadil. In patients of both groups, a study was made of the state of the level of endothelial dysfunction, changes in capillary blood flow and arterio-venular blood shunting. Revascularization of the lower limbs in patients with a high risk of developing reperfusion complications leads to a deepening of endothelial dysfunction. The latter is characterized by a 2.3-fold increase (p<0.001) in the early postoperative period of circulating endothelial cells in the blood, by 2.5 times (p <0.001) endothelin-1, while a 1.3-fold decrease (p<0,05) P-selectin and in 1,7 times (p<0,05) E-selectin. The depth of the lesion of the endothelial system is indicated by a decrease of 29.9 % (p<0.001) in the level of NO. Deepening of endothelial dysfunction after reconstructive-reconstructive surgery is reflected in violations of the function of the microcirculatory bed. It is characterized by a 1.9-fold decrease (p<0.001) of skin perfusion, 2.0 times (p<0.001) in the erythrocyte concentration index and a 14% decrease (p<0.05) in capillary blood flow. This is facilitated by an increase of 14% (p<0.05) in skin perfusion pressure and an increase of 16% (p<0.05) in the resistance index of the microcirculatory bed, which leads to a decrease in tissue oxygenation to a level 3.38±0.14 mm.hg.