THE PLACE OF HYBRID SURGERY IN TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA
Objectives. To optimize accesses to surgical treatment of patients with occlusive-stenotic arterial lesions in case of critical lower limb ischemia by applying hybrid technologies. Methods. The results of examination and surgery treatment of 35 patients with the occlusive-stenotic arterial lesions of the lower limbs have been analysed in the paper. 21 patients has been a two-stage operative treatment with 3-7 days intervals an open reconstruction or endovascular intervention has been firstly performed depending on the type, extent and character of the occlusive-stenotic lesions. In 14 patients the reconstructive-restorative operations have been combined with the endovascular interventions, i.e. the hybrid operations have been performed. The hybrid interventions were primary performed at the occlusive-stenotic lesions of the talocrural segment with local occlusive stenotic lesion of it, i.e. the open reconstruction was carried out firstly and then the endovascular intervention on the shin arteries was done to improve the outflow ways. The endovascular percutaneous balloon angioplasty was combined with stenting in 12 patients. Results. A satisfactory result during 1 year follow-up was observed in 28 (80%) patients; the passability of zone of the open and endovascular reconstruction was observed in 25 (71,4%) and 28 (80%) patients, respectively. In two patients due to reocclusion in the place of the balloon angioplasty the stenting was performed to restore the magistral main blood flow. The lack of conditions for performing repeated endovascular interventions which led to a high amputation of the lower limb have been observed in 5 (14,3%) patients after the percutaneous transluminal balloon angioplasty. Conclusions. Thus, thanks to the application of hybrid technologies during one-year observation period one managed to save the limb in 30 (85,7%) patients.