PREVENTION OF COMPLICATIONS OF SURGICAL TREATMENTOF PATIENTS WITH OCCLUSION OF AORTA-ILIAC SEGMENT

Abstract

Introduction. In modern vascular surgery, occlusive aortic-iliac segment (APS) lesions represent one of the most urgent
problems. It is generally accepted that the detection of APS occlusion testifies to the severity and prevalence of the
atherosclerotic process, and hence the high probability of combined occlusive lesions in other arterial basins. Of particular
importance in this respect is the defeat of the arterial channel of vital organs - the heart and brain.
The aim. Conduct a comparative analysis of the results of surgical treatment of occlusive lesions of APS with correction
and without correction of predictors of complications from vital organs.
Materials and methods. A prospective, nonrandomized clinical study of the results of surgical treatment of 107 patients
with APS lesion in the period from 2010 to 2017 according to the University Hospital of the Semey State Medical University
was conducted. Depending on the tactics of treatment, patients are divided into 2 groups. The 1st group consisted of 59
patients with unstable course of occlusion of APS, who at admission had a clinic of critical ischemia of the lower extremities
and the threat of development of irreversible trophic disorders up to gangrene. In this regard, patients of this group operated
on urgent indications without correction of predictors of complications. The second group consisted of 48 patients who, in the
presence of indications, underwent preliminary surgical correction of the coronary bed and carotid arteries, revascularization
of the pelvic basin, and a preliminary correction of renal failure.
Quantitative evidence in the normal distribution are presented as mean (M) and standard deviation (SD). In the absence
of obedience to the law of the normal distribution of quantitative evidence, the latter are presented in the form M - the sample
mean, Me - the median, Q1 and Q3 - the lower and upper quartiles as scattering measures. Qualitative data are presented
as absolute numbers and percent. Before starting the analysis of quantitative evidence, they were checked for normal
distribution (Q-Q diagram, asymmetry, Shapiro-Wilk criterion for samples of up to 50 observations and Kolmogorov-Smirnov
for samples of more than 50 observations). In the normal distribution, parametric criteria were used to compare quantitative
evidence (Student's t-test, univariate analysis of variance), otherwise non-parametric criteria were used (Mann-Whitney test,
Kruskal-Wallis test). For comparison of qualitative signs, Pearson's χ2, Fisher's exact test, was used. Survival analysis was
performed using the Kaplan-Meier method and the Log-Rank statistical criterion. The criterion of statistically significant
differences was taken as p <0.05.
Results. Complications in the 30-day postoperative period in patients of the 1 st group led to a fatal outcome in 4 (6.8%)
cases. The cause of the lethal outcome was acute myocardial infarction (AMI) - 1 (1.7%), acute cerebrovascular accident (1),
1 (1.7%), acute renal failure (1) ) patient and multiple organ failure - 1 (1.7%) patient. In the second group of patients, early
postoperative complications caused death in 1 (2.1%) patients with progressive multiorgan insufficiency.
Conclusion. Preliminary surgical correction of predictors of cardiac and cerebral complications, correction of renal
dysfunction, revascularization of pelvic circulation can reduce the number of systemic complications, both in the 30-day and
in the distant 5-year postoperative periods, to reduce the 30-day mortality of patients operated on for ASC occlusion.