CROSSOVER BYPASS IN ILIO-FEMORAL POSITION AS A METHOD OF TREATMENT OF UNILATERAL ATHEROSCLEROTIC PROCESS OF THE AORTO-ILIAC SEGMENT
Keywords:bypass, crossover, ilio-femoral, extraanatomical
Objectives. The aim of the study was to analyze the results of the revascularization of the lower extremities with the help of ilio-femoral crossover bypass.
Material and methods. This study was performed within the Republican Hospital of the Republic of Moldova during 2001 – 2021. Patients included in the research met the criteria such as: lower limb ischemia grade III-IV Fontaine, and grade II Fontaine associated with comorbidities such as advanced cardiovascular and pulmonary pathologies, repeated surgical procedures (previous lumbotomies, laparotomies), advanced calcinosis of the abdominal aorta or/and common iliac artery.
Results. Our study included 70 patients. The male/female ratio was 57/13. Central anastomosis was applied on the external iliac artery in 41,5% (n=29), contralateral ilio-femoral bypass – 20% (n=14), contralateral aorto-femoral bypass – 18,5% (n=13), branch of aorto-bifemural bypass – 20% (n=14). The distal anastomoses were applied on the bifurcation of the common femoral artery – 28,5% (n=20), on the deep femoral artery in the rest of the cases. Main comorbidities were arterial hypertension – 87,1%, ischemic heart disease – 85,7%, chronic obstructive pulmonary disease – 54,2%, atrial fibrillation – 52,8%, type II diabetes – 32,8%, cerebrovascular disease – 10%. Perioperative complications included: bypass thrombosis in 3 cases, intraoperative bladder injury – 1 case, early postoperative death – 1 case.
Conclusion. Ilio-femoral bypasses are an alternative to classic method of revascularization in patients who cannot undergo endovascular or open abdominal surgery due to advanced cardiorespiratory pathology, hostile abdomen, porcelain aorta. Compared to femoro-femoral crossover bypass, the formation of non-physiological tortuosities is avoided and does not require bilateral exposure of the inguinal regions that reduces the risk of postoperative infections.
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