microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2024-23-2-60-66microcirculation-1314Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ (КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ)ORIGINAL ARTICLES (CLINICAL INVESTIGATIONS)Преимущества техники гибридной реваскуляризации при лечении протяженных окклюзий поверхностной бедренной артерии и многоуровневых поражений артерий нижних конечностейAdvantages of the hybrid revascularization technique in the treatment of extended occlusions of the superficial femoral artery and multilevel lesions of the lower extremity arterieshttps://orcid.org/0000-0002-7974-9369КучайА. А.KuchayA. A.

Кучай Аршед Ахмад – сердечно-сосудистый хирург, клинический исследователь, Городской центр спасения конечностей

198099, Санкт-Петербург, ул. Косинова, д. 19/9

Kuchay Arshed A. – Cardiovascular Surgeon, Clinical Researcher, City Limb Salvage Center

19/9, Kosinova str., Saint Petersburg,  198099

drarshedcvs@gmail.comhttps://orcid.org/0000-0002-8347-8821ЛипинА. Н.LipinA. N.

Липин Александр Николаевич – д-р мед. наук, профессор, кафедра военно-морской и госпитальной хирургии; руководитель центра спасения конечностей  

194044,  Санкт-Петербург, ул. Академика Лебедева, д. 6

198099,  Санкт-Петербург, ул. Косинова, д. 19/9

Lipin Aleksander N. – MD, Professor, Department of Naval and Hospital Surgery;  Head, City Limb Salvage Center

6, Academician Lebedeva str., Saint Petersburg, 194044

19/9, Kosinova str., Saint Petersburg,  198099

a_lipin2001@mail.ruhttps://orcid.org/0000-0001-5844-2547КурьяновП. С.KurianovP. S.

Курьянов Павел Сергеевич – зав. городским центром диабетической стопы и хирургической инфекции

194354, Санкт-Петербург, Северный пр., д. 1

 

Kurianov Pavel S. – Head, Center of Diabetic Foot and Surgical Infection

1, Severny str., Saint Petersburg,  194354

pkurjanov@gmail.comСанкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская больница № 14»РоссияCity Hospital № 14Russian FederationФедеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С. М. Кирова» Министерства обороны Российской Федерации; Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская больница № 14»РоссияMilitary Medical Academy; City Hospital № 14Russian FederationСанкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская больница Святого Великомученика Георгия». Центр диабетической стопы и хирургической инфекцииРоссияCenter of Diabetic Foot and Surgical Infection, St. George’s City HospitalRussian Federation2024290620242326066Copyright © Кучай А.А., Липин А.Н., Курьянов П.С., 20242024Кучай А.А., Липин А.Н., Курьянов П.С.Kuchay A.A., Lipin A.N., Kurianov P.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1314

Введение. Атеросклеротическое поражение артерий нижних конечностей зачастую носит многоуровневый характер, следствием которого становится инвалидизация населения вплоть до развития постишемического некроза. Общепринятые методы хирургического лечения окклюзии поверхностной бедренной артерии и многоуровневых поражений артерий, тем не менее, характеризуются высокой травматичностью, вызывающей рост летальности среди данной когорты пациентов. Преодоление указанных выше недостатков требовало разработки альтернативных подходов, в частности гибридной реваскуляризации. Цель. Проанализировать собственный опыт проведения указанного выше вмешательства с целью последующей оценки его преимущества. Материалы и методы. В работу включено 80 пациентов, страдающих от хронической ишемии, угрожающей потерей нижней конечности, с окклюзией артерий бедренно-подколенного сегмента длиной >20 см. Исследуемые разделены на две равные группы в зависимости от типа выполненной операции – аутовенозного бедренно-подколенного шунтирования с эндоваскулярной коррекцией каналов оттока (гибридного шунтирования) или аутологичного бедренно-большеберцового шунтирования. Проанализированы клинические и демографические характеристики пациентов, технические особенности вмешательств, а также их прямые и отдаленные эффекты. Оценка проходимости шунта проводилась с использованием таблиц Каплана–Мейера. Различия в показателях между группами определяли при помощи логарифмического критерия. Результаты. Тридцатидневная смертность среди пациентов, относящихся к группе гибридного шунтирования, составила 2,5 % против 4,3 % во второй группе (р>0,05). Частота несостоятельности трансплантата – 5 % против 13 % соответственно. Спустя год после проведенной операции первичная проходимость шунта достигла 77,7 % (95 % ДИ 61,7–93,7) в первой группе. Среди представителей второй группы данный показатель 57,1 % (95 % ДИ 42,9–71,3). Одногодичная выживаемость без ампутации – 82,1 % (95 % ДИ 66,8–97,4) против 69,6 % (95 % ДИ 56,1–83,1) соответственно. Частота ангиосомальной реваскуляризации у больных, которым выполнено гибридное шунтирование, достигла 90,0 %. В другой группе показатель оказался ниже и составил 69,2 % (р=0,006). Выводы. Представленные сведения доказывают высокую эффективность исследуемого способа лечения.

Introduction. Atherosclerotic lesions of the lower extremity arteries often have a multilevel character, the consequence of which is the disability of the population up to the development of post-ischemic necrosis. Conventional methods of surgical treatment of occlusion of the superficial femoral artery (SFA) and multilevel arterial lesions, however, are characterized by high traumatism causing an increase in mortality in this cohort of patients. Overcoming the above disadvantages required the development of alternative approaches, particularly hybrid revascularization. Objective. To analyze our own experience of the above-mentioned intervention in order to further evaluate its benefits. Material and methods. The study included 80 patients suffering from chronic limb-threatening ischemia (CLTI) with occlusion of the femoral-popliteal segment arteries >20 cm long. The subjects were divided into two equal groups depending on the type of surgery performed – autovenous femoral-popliteal bypass with endovascular correction of outflow channels (hybrid bypass) or autologous femoral-tibial bypass (FTB). We analyzed the clinical and demographic characteristics of the patients, technical features of interventions, as well as their direct and long-term effects. The assessment of the shunt patency was carried out using Kaplan-Meyer tables. The differences in indicators between groups were determined using the logarithmic criterion. Results. Thirty-day mortality among patients in the hybrid bypass group was 2.5% versus 4.3% in the second group (p>0.05). The frequency of graft failure is 5% versus 13%, respectively. A year after the operation, the primary shunt patency reached 77.7% (95% CI 61.7-93.7) in the first group. In the second group, this indicator was 57.1% (95% CI 42.9-71.3). One-year survival without amputation was 82.1% (95% CI 66.8-97.4) versus 69.6% (95% CI 56.1-83.1), respectively. The frequency of angiosomal revascularization in patients who underwent hybrid bypass surgery reached 90.0%. In the other group, the indicator was lower and amounted to 69.2% (p=0.006). Conclusions. The presented information proves the high efficiency of the investigated method of treatment.

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The authors declare that there are no conflicts of interest present.