OPTIMIZATION OF TREATMENT TACTICSFOR ATHEROSCLEROTIC LESIONSIN THE FEMOROPOPLITEAL SEGMENT

Abstract

Introduction: One of the most frequent localizations of arterial occlusive diseases leading to the
loss of the limb is the femoropopliteal segment. In the treatment of arterial lesions in the
femoropopliteal segment, surgical methods of treatment (shunting and endovascular methods of
treatment) are used in most cases. If it is not possible to conduct direct revascularization operations,
this category of patients has a high risk of limb amputation at the hip level. In case of femoropopliteal
occlusion, the viability of the limb depends entirely on the condition of the deep femoral artery. Thus,
today, in case of impossibility of direct revascularization operations, the problem of choosing surgical
instruments and optimal treatment of arterial lesions in the femoropopliteal segment remains
unresolved.
Objective: To improve the results of treatment for chronic lower limb ischemia with atherosclerotic
lesions in the femoropopliteal segment by improving the collateral blood flow of the deep femoral
artery.
Materials and Methods: The reseach is prospective, non-randomized and clinical. The results of
the examination and treatment of 111 patients suffering from chronic lower limb ischemia with the
background of occlusion in the femoropopliteal segment are presented. The treatment was held in the
Vascular Surgery Department of the Pavlodar City Hospital No.1 from 2016 to 2017.

The control group consisted of 73 patients who underwent the traditional profundoplasty. The
experimental group included 38 patients who underwent our method: profundoplasty + endovascular
balloon angioplasty. For an objective assessment, the transcutaneous tissue oxygen tension was
measured. A subjective assessment was carried out on the basis of patient complaints and physical
examination, after which the degree of limb ischemia was determined according to the FontainePokrovsky classification. The analysis of postoperative complications was also performed.
The differences between the qualitative variables in the groups were determined using the
Pearson's chi-squared test (χ
2
). To compare the quantitative variables in homogeneous groups
(before and after the treatment) the Wilcoxon signed-rank test was used. To assess the significance
of the differences in the indicators, due to the incorrect distribution of the trait in the variational series,
the Mann-Whitney U-test was used, with p <or = 0,05.
Results: As a result of the conducted operations, we obtained the following data. In group I (n =
73 (65,8%)) the transcutaneous oxygen tension increased from 24,79 ± 5,03 mm Hg up to 32,60 ±
12,41 mm Hg. In group II (n = 38 (34,3%)) the transcutaneous oxygen tension increased from 24,73 ±
5,06 mm Hg up to 37,63 ± 12,00 mm Hg. Deaths, acute myocardial infarctions, as well as acute
disorders of cerebral circulation in the early postoperative period were not observed in any of the
study groups. The failure of thrombectomies, as well as wound infection, caused large lower limb
amputations in 11 patients, which accounted for 10% of the total number of patients in both groups.
Conclusion: The transcutaneous oxygen tension measurement in the control group showed an
increase in the average transcutaneous tension from 24,79 to 32,60 mm Hg.
In the second group there was also an increase in the average transcutaneous tension from 24,73
to 37.63 mm Hg. The comparative analysis of the groups after the surgical intervention showed the
criterion U = 900, and p = 0,002, which is less than the critical value of p = 0,05. Thus, there is a
significant increase in the transcutaneous oxygen tension of tissues when using the proposed method
of surgical intervention.