RU-2861579-C1 - METHOD FOR TREATING OCCLUSIVE-STENOTIC LESIONS OF ARTERIES OF FEMOROPOPLITEAL SEGMENT IN ABSENCE OF ADEQUATE AUTOVENOUS GRAFT

RU2861579C1RU 2861579 C1RU2861579 C1RU 2861579C1RU-2861579-C1

Abstract

FIELD: medicine; cardiovascular surgery. SUBSTANCE: under combined anaesthesia, performing accesses in the upper third of the leg, assessing the popliteal artery and the distal bed. Then, performing access in the lower third of the thigh, openly isolating the popliteal artery and then applying tourniquets to it, then harvesting the available segment of the great saphenous vein on the thigh or leg, performing hydrodissection thereof, wherein the segment of the autogenous vein graft is 15 cm, with a diameter of 5-6 mm. Then, performing arteriotomy on the popliteal artery in the upper third of the leg, assessing the vascular bed. Forming a distal anastomosis between the popliteal artery or the tibioperoneal trunk and a reversed autogenous vein with 6/0 Prolene suture. Passing the shunt to the artery in the lower third of the thigh, performing arteriotomy on the popliteal artery via the access in the lower third of the thigh, then using a Moll Ring Cutter device to perform retrograde closed loop endarterectomy from the popliteal and superficial femoral artery in the lower third of the thigh to the middle third or the orifice of the superficial femoral artery, wherein performing ultrasound control of the plaque transection zone. Forming a proximal anastomosis with 6.0 Prolene suture between the popliteal artery and the proximal portion of the autogenous vein shunt and starting blood flow. Evaluating the reconstruction zone by palpation or using ultrasound scanning, or angiography of the arteries of the operated limb and the reconstruction zone. Layer-by-layer suturing of the wound. EFFECT: restoration of blood flow through the artery by removing the atherosclerotically altered intima from the artery lumen, while the disobliterated vessel retains its own innervation, blood supply, physiological diameter and flexibility, and blood flow through the collateral branches is also restored due to the release of their orifices, in addition, to reduce the level of infectious complications, reduce time costs. 1 cl, 1 ex

Inventors

FOMIN VLADIMIR SERGEEVICH
Oleksiuk Igor Bogdanovich
Shatravka Aleksei Vladimirovich
Fokin Aleksei Anatolevich
LAPTEV KIRILL VLADIMIROVICH
Maslianiuk Oleg Vladislavovich
Suvorov Sergei Aleksandrovich
Oleksiuk Anastasia Vadimovna

Dates

Publication Date: 20260506
Application Date: 20250722

Claims (1)

A method for treating occlusive-stenotic lesions of the arteries of the femoropopliteal segment in the absence of an adequate autovenous graft, characterized in that under combined anesthesia, approaches are made in the upper third of the leg, the popliteal artery and distal bed are assessed, then an approach is made in the lower third of the thigh, the popliteal artery is openly isolated and then taken on tourniquets, then an existing section of the great saphenous vein on the thigh or leg is collected, hydropreparation is performed, while the section of the autovenous explant is 15 cm, with a diameter of 5-6 mm, then an arteriotomy is performed on the popliteal artery in the upper third of the leg, the vascular bed is assessed, then a distal anastomosis is formed between the popliteal artery or tibioperoneal trunk and the reversed autovenous thread Prolene 6/0, then the bypass is carried out to the artery in the lower third of the thigh, then an arteriotomy is performed on the popliteal artery using an access in the lower third of the thigh, then using the Moll Ring Cutter device, a retrograde closed loop endarterectomy is performed from the popliteal and superficial femoral artery in the lower third of the thigh to the middle third or orifice of the superficial femoral artery, while ultrasound control of the plaque excision zone is performed; then a proximal anastomosis is formed with a 6.0 Prolene thread between the popliteal artery and the proximal section of the autovenous bypass graft and blood flow is started; the reconstruction zone is assessed by palpation or with the help of ultrasound scanning, or angiography of the arteries of the operated limb and the reconstruction zone; then a layer-by-layer wound suture is performed with drainage.

Description

The invention relates to medicine, more precisely to cardiovascular surgery, and can be used in the surgical treatment of arteries of the lower extremities with damage to the femoropopliteal segment with a length of more than 25 cm and in the absence of an autovein suitable for bypass. Cardiovascular diseases are the most common disease worldwide. The prevalence of chronic obliterating arterial disease of the lower extremities ranges from 0.6% to 7.5% of the population, depending on age [3]. Along with coronary heart disease and cerebrovascular insufficiency, chronic lower extremity ischemia, also known as peripheral atherosclerosis, is a pressing issue in modern medicine. Its high morbidity, leading to disability and mortality, causes significant economic and population losses. The main objective of reconstructive vascular surgery is to select the optimal method for restoring blood flow, eliminating ischemia in order to improve the quality of life and save the limb [10]. The extent of the occlusive-stenotic lesion [5], the general condition of the patient, anatomical features, previously undergone interventions (requiring the collection of plastic material in the form of GSV and SSV), as well as the economic component [12] are important in choosing the tactics for reconstruction of arteries of the lower extremities. The number of patients with severe damage to the femoropopliteal-tibial segment is large, and a section of the great saphenous vein of the required length is not always available [9]. Numerous studies have been devoted to the choice of methods for reconstruction of the femoropopliteal arterial segment. These include the use of autologous veins, synthetic prostheses, xenografts, loop endarterectomy, combined bypasses, endovascular surgeries, femoropopliteal or femorotibial autologous vein bypass surgery with the simultaneous introduction of a cellular biograft, and the formation of an arteriovenous fistula below the distal anastomosis of the femorotibial bypass graft. All of these studies have their advantages and disadvantages. The most common method is classical autovenous femoropopliteal bypass above the knee joint space, supplemented by various methods of endarterectomy from the popliteal artery [2], or X-ray endovascular reconstruction (balloon angioplasty and stenting) [7]. The use of autovenous veins is the "gold standard" for infrainguinal reconstructions, as autovenous grafts have higher patency than synthetic ones, and they are also free of tissue incompatibility [11]. Autovenous bypass is used for extended (more than 25 cm) occlusive-stenotic lesions of the lower extremity arteries. Autovenous veins can also be used for critical ischemia, when there are non-healing infected wounds on the foot. However, the use of long autovenous grafts has its drawbacks: the small diameter of the vein in the proximal section does not provide sufficient blood flow, and the wide distal section causes an increase in peripheral resistance and can lead to early conduit thrombosis. Also, the wide end of the GSV may be deformed during anastomosis formation; the divergent shape of the shunt may not ensure laminar blood flow and leads to a decrease in blood flow in the distal parts of the shunt, which leads to thrombosis [6]. In his work, Veith FJ used short autovenous bypass grafts (8-33 cm) in popliteal-tibial bypass. The author concluded that bypass grafting using short venous conduits offers many real and potential advantages for limb salvage compared to the use of long venous conduits or other types of reconstruction [15]. Endovascular arterial reconstructions involve balloon angioplasty of arteries with stenting when necessary. A major advantage of these procedures is their minimally invasive nature, which means no large postoperative wounds are left, reducing the risk of infection and lymphedema. The duration of the procedure is also reduced, anesthesia is more gentle, multiple dressings are not required, and hospitalization time is shortened. However, this method also has its drawbacks. These include: stent restenosis and thrombosis, stent migration, pulsating hematomas leading to false aneurysms, fistula formation, arterial perforation, stent blockage and subsequent occlusion of collaterals, allergy to iodine-containing drugs, renal failure, and radiation exposure. Such complications can occur in 12% of interventions [4]. The closest approach to the proposed invention is a method for the combined treatment of occlusive-stenotic lesions of the femoropopliteal arterial segment, which we have adopted as a prototype. The operation consists of balloon angioplasty and stenting (if necessary) of the superficial femoral artery and short popliteal-tibial bypass grafting with an autologous vein [13]. Description: Under anesthesia, an autologous vein (great saphenous vein with a diameter greater than 2.5 mm) was harvested. Next, the endovascular stage was performed, which consisted of balloon angioplasty of the