Embolism of aorta bifurcation

Results of treatment of 146 patients with embolism of aorta bifurcation have been analyzed and compared to that of extremity arteries. The severity of general condition of the patient, ischemic intoxication, postoperative complications are responsible for high death rate: postoperative mortality--53.7%, general--60.9%. The main measures of improving the treatment results are as follows: early hospitalization to a specialized vascular surgery unit, urgent operation, treatment of ischemic intoxication and adequate postoperative rehabilitation.     

Surgery of acute thrombosis of the bifurcation of the aorta and arteries of the extremities

An analysis of results of the surgical treatment of 826 patients with acute thromboses of bifurcation of the aorta and main arteries of extremities enabled the author to draw a conclusion that indications for radical reconstructive operations should become wider. This can twice reduce the incidence of the development of gangrene and 1.5 times-lethality. The optimal method of treatment of acute arterial thromboses is thought to be thrombectomy in combination with shunts and prostheses.     

Kidney involvement in acute occlusion of the bifurcation of the aorta and the major arteries of the lower extremities

A total of 162 patients with acute thromboses and embolism of bifurcation of the aorta and the major vessels of the extremities were studied for renal performance before and after the corrective surgery. In this line the values of central hemodynamics, electrolytic balance, acid-base composition of blood and the hemostatic system were investigated. The author established the relation between the renal dysfunction and the character of the underlying disease which was the cause of thromboses or embolism, the level of occlusion and the degree of ischemic lesions in the extremity mainly. It was revealed that in case of an increase in the ischemic lesion of the extremity, the kidney performance decreased. In patients with recovered blood flow in the extremities, the failure of the renal function was developing due to the inclusion syndrome. The author distinguished three stages of the syndrome severity and related functional disorders of the kidneys. Renal dysfunction should be corrected even in case of mild ischemic lesions. The authors presented the principles of their correction as well. Acute renal failure can be regarded as a death cause only in 7.7% of expired persons who had acute thromboses of arterial embolism. The author came to the conclusion that in patients with the recovered blood flow pathological changes in the morphology and functioning of the kidneys were mainly associated with the disorders in renal hemodynamics, the mechanical blockage of tubules by myoglobin degradation products, decompensated metabolic acidosis, disseminated intravascular coagulation syndrome and immediate exposure of the renal parenchyma to toxins of protein nature.     

Embolism of the mesenteric arteries in patients with acute occlusion of the aorta and main arteries of the limbs

The article deals with retrospective analysis of the results of treatment of embolism of the mesenteric arteries in 111 patients. The condition developed after restorative operations on the main arteries of the limbs carried out in 2,984 patients with acute ischemia of the limbs. The analysis showed that a series of diagnostic and tactical errors were made in different stages of treatment. To improve the results of management, early exact diagnosis of embolism of the mesenteric arteries is necessary which can be made only by means of angiography which is undertaken as an emergency procedure for vital indications. Operative treatment should be started with laparotomy and restoration of circulation in the mesenteric channel after which operation on the vessels of the limbs is conducted.     

Reducing mortality rate in acute thromboembolism of aortic bifurcation and major arteries of the extremities

From generalization of experience in surgical and nonoperative treatment of 820 patients with acute thrombosis and embolism of the bifurcation of the aorta and the main arteries of the limbs the author claims that the following factors played a considerable role in improving the results of treatment and reducing the mortality: mastering and improving the techniques of operative intervention, elucidating the role of certain pathogenetic mechanisms of the origin of thrombosis and embolism depending on the character of the principal disease, preventing and treating the inclusion syndrome, and changing to active surgical tactics. The mortality fell to 13%. The possibility of predicting the outcome of the operation is shown. The prevention and treatment of diseases causing thrombosis and embolism are the further means of reducing the mortality.     

Simultaneous reconstructive operations in combined lesions of the coronary arteries, abdominal aorta and arteries of the lower extremities]

The work deals with the results of one-stage reconstructive surgical interventions in 15 patients with affection of the coronary arteries, abdominal aorta, and lower limb arteries. All patients underwent operation for the creation of an aortocoronary shunt in combination with various types of vascular reconstructive operations, including the formation of an ascending aorta -bifemoral shunt in 3 patients. The total hospital mortality was 26.7%. The authors discuss the indications and the surgical tactics of one-stage reconstructive interventions in combined affection of the coronary and peripheral arteries.     

Reconstructive reoperations on abdominal aorta and main arteries of extremities in the synthetic prosthesis thrombosis

The results of surgical treatment of 176 patients aging from 42 to 75 years, to whom earlier the reconstruction operation on abdominal aorta and the lower extremities main arteries was performed, were analyzed. The causes of the synthetic prosthesis thrombosis occurrence were studied, individualized surgical tactics, depending on the hip arteries inflow and outflow, was substantiated. There was proposed an access to a. femoris profunda and the profundoplasty method. The immediate and late follow-up results of their application are satisfactory.     

Surgical treatment of patients with combined stenosis of the coronary arteries, abdominal aorta and arteries of the lower extremities

The authors in 145 patients with combined atherosclerotic lesion of the coronary arteries, abdominal aorta and vessels of the lower extremities performed the one-stage, staged operations, aortocoronary shunting alone, the vascular operations alone. The total lethality was 7.6%, the postoperative--6.3%.