Husak M. Repeated surgery on the aortic / iliac-femoral-popliteal arterial bed in the remote postoperative period

The dissertation is devoted to the prevention of late complications of atherosclerotic lesions revascularization of the aortic / iliac-femoral arterial zone and to the increase of efficiency of surgical treatment of late complications of the postoperative period of aortic / iliac-femoral reconstruction by improving their methods according to the causes and nature of these complications. The paper analyses the results of examination and surgical treatment of 522 patients with atherosclerotic lesions of the aorta and main arteries of the lower extremities operated during 2006–2014, 148 of which were hospitalized with late complications of surgical treatment within the period of 2014–2019. It was found that the hemocoagulant state of blood in patients with late thrombosis of the aortic / iliac-femoral alloprosthesis is characterized by increased levels of coagulation and aggregative properties of blood, which at the intraoperative stage of central blood flow restoration and reconstruction of the primary alloprosthesis distal anastomosis as well as of the outflow pathways is activated by IIa factor of hemocoagulation cascade, which increases the content of soluble fibrin-monomer complexes, fibrinopeptide A, products of degradation of fibrin, fibrinogen in the blood and strengthening the blood aggregate properties on the background of the depressed state of the fibrinolytic unit. It was found that in patients with revascularized aorto / iliac-femoral arterial zone and multilevel reconstruction of the main arterial bed progression of atherosclerotic process promotes on average by 2.8 years faster formation of recurrence of chronic arterial insufficiency than in patients with reconstruction of only one level of the main arterial bed of the lower extremity. Good results of the alloprosthesis distal anastomosis reconstruction with revascularization of ischemic extremities through the deep femoral artery system in patients with recurrence of chronic arterial insufficiency and late thrombosis of the aorto / iliac-femoral arthroplasty branch confirm the important role of the deep femoral artery in ensuring blood supply in multi-storey stenotic-occlusive lesions of the lower extremity arterial bed.