The choice of femoropopliteal bypass surgery below the knee joint gap

Objective. To determine the best way of femoropopliteal bypass surgery below the knee joint gap in patients with critical lower limb ischemia based on the type of venous system structure. Material and methods. The analysis of complex examination and treatment of 120 patients with critical lower limb ischemia on the basis of atherosclerotic lesion of the femoral-popliteal-tibial segment was conducted. According to femoropopliteal bypass technology patients were divided into four statistically homogeneous groups of 30 people each. Patients of the 1st group underwent a typical traditional autovenous bypass with reversed great saphenous vein. In the 2nd group, the operation was carried out according to the procedure in situ, in the 3rd group - the original technology by autovenous free graft with the destroyed valves without vein reversion, in the 4th - with the help of biological prosthesis of bovine internal thoracic arteries. Results. Compared with the use of reversed vein the original treatment technology allowed to increase 1.5 times the volumetric blood flow in the limbs in the immediate postoperative period, the main blood flow - 1.6 times, the microcirculation level - 1.3 times. Compared with in situ method and using biological prosthesis statistically significant differences were not found. Number of early postoperative complications in the 3rd group decreased compared with the 1st group by 23.4%, compared with the 2nd group - by 13.3%, with the 4th - by 6.7%. In the late postoperative period we were able to reduce the number of late graft thrombosis in the 3rd group by 40% compared with the 1st group, by 13.3% compared with the 2nd group and by 66.6% compared with the 4th group. 2 years after surgery bypass works in 36.7% of patients of the 1st group, in 70% of the 2nd group, in 83.3% of the 3rd group, in 16.7% of the 4th group. We managed to save the limb in 60% of patients in the 1st group, in 83.3% of the 2nd group, in 90% of the 3rd group and in 63.3% of the 4th group. Conclusion. The choose of the method of reconstructive surgery below the knee joint gap should be conditioned by the type of the lower extremities venous system structure. In the trunk type the execution of femoropopliteal bypass with reversed vein is recommended. In the skirmishing type the biological prosthesis of bovine internal thoracic arteries may be applied as a shunt. In the intermediate type the state of the distal vascular bed should be taken into account: satisfactory condition is appropriate to apply in situ technique, and good condition - free autovenous graft with the destroyed valves.

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