NIKUL'NIKOV P. Surgical Treatment of Patients with Multiple and Combined Affection of Aorta Arch Extracranial Ramus, Abdominal Segment of Aorta and Blood Vessels in Lower Limbs.

This paper deals with issues of surgical treatment of patients with chronic ischemia of cerebrum and lower limbs caused by occlusive and stenotic affection of extracranial arteries, abdominal segment of aorta and blood vessels in lower limbs. Based on the results of fundamental research of mechanisms of cerebral and peripheral blood circulation, a new approach to the tactics of surgical treatment is presented herein.The findings of hemodynamics research show that ischemic hypoxia caused by insufficient blood onflow is a leading factor in the pathogenesis of chronic ischemia of cerebrum and lower limbs. Here a condition of cerebral blood flow depends upon a degree of summative stenosis of extracranial vessels. A negative effect of critical ischemia of lower limbs on the condition of cerebral blood supply is proven.Proposed and substantiated by the results of hemodynamics research is a differentiated surgical tactic depending on a degree of organs ischemization, cerebrum tolerance to ischemia and value o f cerebral perfused reserve. The application of complex approach to the assessment of regionar hemodynamics condition, selection of surgical treatment recommendations and tactics, and the original methods of reconstructive surgery have led to positive results in 89,4% of patients.