Features of the treatment of patients with steno-occlusive arterial diseases of the arteries of the infrarenal aorta by the endovascular method

Abstract

Resume. to improve the results of surgical treatment of atherosclerotic steno-occlusive lesions of the arteries of the infrarenal aorta, through the differentiated use of modern endovascular technologies.Materials and Methods. The results of treatment of 243 patients who were operated on with various endovascular methods were analyzed. The patients were divided into two subgroups. The comparison group, retrospective, which included 160 patients (65.8%) operated on from 2014 to 2018, who underwent a standard complex of examination and treatment, and the study group, the main, prospective, which was the first representative, which included 83 patients ( 34.2%), operated from 2019 to 2021, where the angiosomal concept of revascularization of distal arterial segments was applied, the use of ultrasound navigation, rotary mechanical aspiration technologies, balloons and stents with a therapeutic coating, thrombolysis, as well as alternative puncture approaches to arteries.Among the complications in the early postoperative period, thrombosis was diagnosed in both study groups, which was detected in 21 (10.6%) patients. The frequency of thrombosis was statistically higher (p <0.05) in 18 (11.53%) patients in the comparison group than in 3 (7.14%) in the main group. Amputation was performed in 15 patients of both groups (in 12 (7.5%) in the comparison group, in the main group in 3 (3.6%).Mortality in the early postoperative period was 2.56% in the comparison group (4 patients died), in the main group there was no mortality in the early postoperative period.In the main group in the period up to 1 year, the support function of the limb was preserved in 77 (92.8%) cases, in the comparison group - in 114 (71.3%). Conclusions. The methods of choice in the restoration of steno-occlusive lesions of the arteries of the infrarenal aorta are endovascular revascularization techniques. Compliance with the angiosomal concept of restoration of the arterial bed in the distal segments, the use of balloons and stents with a therapeutic coating, the use of regional thrombolytic therapy gives the best early and long-term results of limb preservation. Puncture of arteries under ultrasound navigation helps to reduce complications.