Ahmed S. Critical ischemia at the remote period after the multilevel reconstruction of atherosclerotic occlusion of the terminal segment of abdominal aorta and main arteries of lower extremities.

Dissertation is dedicated to the problem of surgical treatment of patients with the late thromboses after the multilevel reconstruction of main arteries of lower extremities. Correlation of causes and character of clinical course of relapse of ischemia of lower extremities with various clinical and anamnestic factors and features of primary reconstruction is revealed. As main causes of development of the late thrombosis are taken hyperplasia of neointima of distal anastomosis (37.6 %) and progressing atherosclerotic process (40.6 %). In 16.6 % of patients with late thrombosis of one branch of aorto-bifemoral Bypass developed as a result of high peripheral vascular resistance, compared with contralateral lower limp.In 75.1 % supervised patients the operation of renewing the central blood stream was carried out by the method of retrograde thrombectomy from the prosthetics or its branch. The aorta-bifemoral reprosthetic was carried out in (15.8 %) cases, including replacement of trombosis-affected prosthetic branch - in 1.5 % cases. When restoring the permeability of the distal anastomosis in 25 supervised patients the distalization of bifurcation of femoral arteries was accomplished. Thus 47 of the supervised patients undergoes resection of the previous distal anastomosis. The need for the repeated reconstruction of distal anastomosis and femoropopliteal area existed for 61 patients. In these cases, the V-type autovenous anastomosis was formed which was anastomized with the branch of aorto-femoral prosthesis and its distal segments with the deep femoral artery and with popliteal artery on different levels.