Zhuk R. Modern principles of surgical treatment of late aorto-femoral graft thrombosis

The dissertation is devoted to the problem of surgical treatment of late aorto-femoral graft thrombosis. Correlation of the reasons and character of a clinical course of leg ischemia recidive with separate clinical and anamnestic factors, features of primary reconstruction, regional hemodynamic parameters has been established. Diagnostic value of duplex ultrasound scanning has been determined and its independent application in the estimation of operability and definition of surgical tactics has been proved. Advantages of distal anastomotic reconstruction by deep femoral artery revascularization without allocation of previous anastomosis have been shown. The method of distal anastomotic reconstruction has been developed for the cases of severe deep femoral artery lesions and need for additional femoro-distal bypass. Efficacy of preventive carotid endarterectomy in patients with late aorto-femoral graft thrombosis has been proved. Low-molecular-weight heparins in prevention of early rethrombosis after redo reconstructive operations and prostaglandin Е1 at residual leg ischemia after deep femoral artery revascularization have been applied. Complex diagnostic and surgical tactics has improved early positive results up to 90,8 %, has reduced necessity of major amputations up to 6,1 %. Parameters of cumulative patency and preservation have made, accordingly, 81,4 % and 85,6 % on 1-st year and 56 % and 67,8 % on 5-th year of supervision.