Bogdan V. Improvement of regional blood flow in reoperations for recurrent ischemia after aortofemoral reconstructions

Object of the study: obliterating diseases of the abdominal aorta and large arteries of the lower extremities. Purpose of the study: to improve the results of treatment for thrombosis of aortofemoral grafts by optimization of surgical tactics and development of new methods of repeated operations with the consideration of correction of regional hemodynamics disturbances. Methods of the study: general clinical, biochemical, coagulogical, angiographic, ultrasound, statistical. Practical significance of the obtained results: Individualized surgical tactics was worked out and used in patients with stenoses and thromboses of aortofemoral grafts. A surgical approach to the deep femoral artery and a method of extended adapting profundoplasty in repeated reconstructive operations in patients with aortofemoral artery grafts was worked out and introduced into the work of the hospital at Institute for General and Urgent Surgery (Academy of Medical Science of Ukraine). Recommendations for improvement of the results of surgical treatment in stenoses and thromboses of aortofemoral grafts were worked out. The use of the new method of extended profundoplasty with indirect thrombectomy from the graft and reconstruction of distal anastomosis allowed to increase the number of positive results of repeated operations on the aortofemoral segment by 17%. Novelty: Basing on the study of the causes of thromboses of aortofemoral grafts, analysis of unfavorable outcomes of primary and repeated reconstructive operations, the directions of prevention of these complications were determined. The study of the character the disturbances in regional blood flow allowed to determine the indications to different methods of reconstructive surgery in patients with thromboses of aortofemoral grafts and individualize therapeutic tactics. A new surgical approach to the deep femoral artery was worked out for repeated reconstructive operations in patients with aortofemoral artery thromboses (Positive decision about Patent issue "Method of surgicalapproach to deep femoral artery in occlusion of the superficial femoral artery № 95052428 dated 19.05.1995). Indications to different types of profundoplasty in repeated reconstructive operations depending on localization and extend of the thrombosis of the aortofemoral graft were determined. Degree of introduction: Main ideas of the work were reported and discussed at Jubilee Conference of Kyiv Medical Academy for Post-graduate Training named after P.L. Shupik (2001), session of the Learned Council of Institute for General and Urgent Surgery (Academy of Medical Science of Ukraine). Area of application: medicine, surgery.