Sequential aortofemoropopliteal/distal bypass for treatment of critical lower-limb ischaemia.

Multilevel arterial occlusive disease is often the main cause of critical ischaemia of the lower limb. The aim of this study was to determine the diagnostic criteria that could help select patients for sequential aortofemoropopliteal/distal reconstruction and to compare the results after simultaneous and two-stage surgery. Some 1953 aortofemoral reconstructions were performed during a 6-year period (1987-1992). In 245 cases (12.5%) sequential aortofemorodistal (popliteal or tibia) procedures were performed for critical limb ischaemia Fontaine classification grade III and IV. Two-segment reconstructions were performed in one stage in 161 cases (group A), and two separate operations were performed, the outflow procedure usually following within 12 months after inflow surgery, in 84 cases (group B). The preoperative mortality rates were 3.2% in group A (five deaths) and 5.9% in group B (five deaths). Limb salvage rates were 95.6% at 1 year and 90.4% at 5 years for group A and 88.8% at 1 year and 80.0% at 5 years for group B. Primary inflow bypass patency rates were 97.7% at 1 year and 91.3% at 5 years for group A and 93.4% at 1 year and 76.3% at 5 years for group B, while secondary inflow bypass patency rates were 98.8% at 1 and 5 years for group A, and 95.3% and 88.3% at 1 and five years respectively for group B. Primary outflow bypass patency rates were 91.4% at 1 year and 65.5% at 5 years for group A, and 84.9% at 1 year and 59.4% at 5 years for group B. Secondary outflow bypass patency rates were 92.2% at 1 year and 81.8% at 5 years for group A, and 86.1% at 1 year and 65.9% at 5 years for group B. The data demonstrate that single-stage multisegment reconstruction for multilevel arterial occlusive disease is a safe and effective method of treating critical limb ischaemia.

Revascularisation of distal tibial and pedal arteries.

The results of 1062 reconstructive operations performed on the tibial and peroneal arteries in patients with Fontaine stage III or stage IV disease are presented. A group of 121 patients in whom the anastomosis was to the tibial or peroneal artery with no direct flow to the foot, and a group of 59 patients with direct anastomoses to the pedal arteries, are analysed in detail.

[Effect of progressive arteriosclerosis on late results of the reconstruction of the aorta and peripheral arteries]. / Vliianie progressirovaniia ateroskleroza na otdalennye rezul'taty rekonstruktsii aorty i perifericheskikh arterii.

The results of repeat angiographies, conducted for late impairments of the reconstructed artery, were reviewed in 912 patients after reconstructive operations on the abdominal aorta and its main branches. Progress of atherosclerosis in intact arteries was the cause of impairment in 65.9% of cases. Contribution of diabetes mellitus, tobacco smoking and arterial hypertension is discussed.

Secondary arterial repair after aortoiliac surgery.

Late complications after operations on aorta and iliac arteries are analyzed in 763 patients with athesclerosis over 15-year period. Indications for recurrent reconstructive operations are presented, and the results of these operations are analyzed depending on surgical technique, incidence of recurrent thromboses and types of complications. Angiography, rheovasography, pathohistological and microscopic studies, raster electron microscopy, IR-spectroscopy were used in post-operative period. On the basis of the obtained data the following conclusions have been drawn. For more than a quarter of patients operated for aorto-iliac occlusions it was necessary to perform recurrent reconstructive operations in late post-operative period. The incidence of recurrent operations depends on many factors: stage of ischemia, nature of atherosclerotic lesions, technique of reconstruction. In primary operations profundoplasty was performed in comparatively rare cases.

[Clinical aspects of circulatory disorders in the vertebral arteries and the possibilities for their surgical treatment]. / Nekotorye klinicheskie aspekty narushenii krovoobrashcheniia v pozvonochnykh arteriiakh i vozmozhnosti ikh khirurgicheskogo lecheniia.

Experience in the follow-up of 84 patients who underwent operation for transient cerebral vascular insufficiency in the vertebro-basilar bed is summarized. It was found that most patients with abnormally tortuous or anomalously branching vertebral arteries had transient disorders of the carciac rhythm or increased arterial pressure. Operative treatment of such patients contributes to correction of the neurologic symptoms and leads to normalization of the cardiac rhythm and arterial pressure.

[10-year experience of surgical treatment of occlusive diseases of the aorta and main arteries]. / Desiatiletnii opyt khirurgicheskogo lecheniia bol'nykh s okkliuzionnymi porazheniiami aorty i magistral'nykh arterii

The authors report the results of 1268 reconstructive operations in cases of various ischaemic syndromes. Surgical technique and indications for surgery are discussed. The clinical material consists of 115 reconstructive operations on the supraaortic branches, 462 operations in the aortoiliac segment, 57 reconstructions of the abdominal aorta and its visceral branches, as well as 652 reconstructive procedures on the arteries below the inguinal ligament. The latter operations include 70 femorotibial venous bypasses in patients with rest pain and gangrene.