IN-HOSPITAL AND MID-TERM RESULTS OF IMPLEMENTING THE HYBRID SURGICAL TECHNIQUE FOR EXTENDED OCCLUSION OF THE SUPERFICIAL FEMORAL ARTERY IN COMBINATION WITH THE LESION OF CRURAL ARTERIES IN CHRONIC LIMB THREATENING ISCHEMIA

Kuchay Arshed A., Lipin Alexander N.

Aim: to improve revascularization outcomes and develop a hybrid approach for extended superficial femoral artery (SFA) occlusion in combination with tibial outflow. Material and Methods. A retrospective, cohort study was performed, which included patients with the initial severity of CLTI of stage 4 according to A.V. Pokrovsky (study group 1 - 120 patients underwent hybrid interventions and control group 2 - 138 patients underwent femorotibial bypass). An analysis of baseline, early, and mid-term outcomes, including mid-term survival and graft patency, was performed. Results. In-hospital mortality was 7/258 cases, 2.71% (3/120, 2.5% of cases in group 1 and 4/138, 2.89% in group 2). There were no cases of early infrainguinal shunt thrombosis in the interval between bypass grafting and transluminal balloon angioplasty (PTA). The amputation rate in the early postoperative period was 3/120, 2.5% vs 2/138, 2.9% for groups 1 and 2, respectively, p> 0.999. Thrombosis of the crural artery (3/120, 2.5%) or thrombosis of the contralateral common femoral artery (3/120, 2.5%) after two-stage hybrid reconstruction in the early hospital period did not lead to the development of symptoms of critical ischemia of the operated lower limb. The mid-term amputation-free survival and bypass patency were 77.7% (95% CI 61.7-93.7) vs 57.1% (95% CI 42.9-71.3) and 82.1% (95% CI 66.8-97.4) vs 69.6% (95% CI 56.1-83.1) after hybrid surgery and femorotibial bypass, respectively. Conclusion. As compared with the classical method of treating extended occlusion of the SFA in combination with damage to the outflow tract in CLTI, the hybrid approach is an effective, modern, reliable and safe treatment method, and also has a high potential for complete rehabilitation of patients, providing a higher primary patency of the shunt with comparable rates of limb preservation, survival and healing of the trophic defect compared to isolated femorotibial bypass.

Keywords:chronic limb-threatening ischemia; extended occlusion; multilevel lesions; hybrid surgery