Vascular surgery - methods and alternative possibilities. Complications after surgery. Bypass indications

Treatment of atherosclerosis of the lower extremities is conservative and surgical. Often from surgical methods removal of a thrombus and angioplasty of the lower extremities is used. If the disease is already in an advanced stage, after the death of soft tissues and the development of a gangrenous process, the surgeon performs surgical excision of necrotic areas of soft tissues, then the excised areas are covered with a skin flap.

If atherosclerosis of the lower extremities has passed into running stage, conservative treatment is no longer effective, an operation is chosen that can maximize the patient's quality of life after treatment, his state of health.

Nowadays, intravascular surgery is the method of choice for atherosclerosis. Surgical interventions, allowing to restore the blood flow of the lower extremities, significantly reduce the number of amputations by several orders of magnitude. Plastic surgery vessels of the lower extremities is aimed at restoring the patency of the arteries of the lower extremities and restoring the lumen of the stenotic artery.

For intervention, a special catheter is used, which has a small balloon at the end. It is introduced into the narrowed place, the balloon begins to inflate under pressure until the patency of the arterial bed of the lower extremities is restored.

If a therapeutic effect could not be achieved, a frame made of a special metal is inserted into the obstruction zone. Its purpose will be to maintain the normal diameter of the vessel and ensure its patency.

If there is no improvement after the operation, the issue of open vascular bypass is decided. However, balloon angioplasty often avoids extensive and traumatic interventions and improves the patient's quality of life after treatment.

In patients diagnosed with Leriche's syndrome, endovascular operations can improve the state of blood flow in the vessels of the lower extremities.

Vascular plasty and stenting, carried out in the line of the superficial femoral artery, eliminates the phenomena of chronic vascular insufficiency that arose after blockage of the lumen of the artery by a thrombus. A number of leading surgical clinics prefer this type of intervention.

In a number of clinics, the described surgical treatment is widely used to restore patency. popliteal arteries. The method of treatment of atherosclerosis has been tested by surgeons relatively recently. Previously, stenting of the popliteal vessels caused frequent side effects in the form of breakage of the stent or its displacement during bending lower limb in knee joint. At present, stents resistant to strong kinks have found application. Scientific developments are being actively carried out in the field of creating stents that can dissolve over time.

Complex surgical treatment of atherosclerosis of the vessels of the lower extremities is carried out using balloons with drug coatings. With this method surgical intervention the balloon is impregnated medicinal substances, which, after the introduction of the balloon into the vascular bed, are absorbed into the vascular wall, prevent further development inflammatory process and pathological proliferation of the endothelial membrane.

What are the advantages of balloon plastic surgery

The results of balloon plastics

The normal passage of blood through the vessels after plastic surgery in the iliac arteries persists for five years from the time of surgery in the vast majority of operated patients.

Follow-up data of observation of patients allow the surgeon to recognize the repeated deterioration of the condition in a timely manner, if necessary, to treat the condition. For this, the patient undergoes twice a year ultrasound dopplerography and does a CT scan once a year. Provided that the patient is being dispensary observation and timely treatment is prescribed, the function of walking in a person is preserved throughout life.

The long-term results of balloon angioplasty or stenting in the femoral arteries are clinically and statistically comparable with bypass grafting of the femoropopliteal segment with the installation of an artificial vascular prosthesis.

In 80% of operated patients, vascular patency was maintained for three years. If the patient was engaged in therapeutic walking, there was no need for re-intervention. This method of therapy allows to eliminate the development of necrotic complications, to prevent gangrenous complication.

Aortofemoral bypass

The main indications for the operation will be the conditions:

Occlusion in line abdominal aorta with an increase in arterial chronic insufficiency.
Blockage in the pool iliac arteries with the condition that it is impossible to carry out endovascular plastic surgery.
Aneurysm of the wall of the abdominal aorta in the infrarenal region.

Aorto-femoral bypass surgery is now considered common and in a radical way prevention of severe ischemia and limb amputation. According to statistical studies, the loss of limbs among patients with vascular lesions accounts for up to one fifth pathological conditions. In the case of a well-performed operation in the abdominal aorta, the risk of amputation is reduced to 3%.

Intervention technique

The meaning of surgical intervention for atherosclerosis is to isolate the part of the aorta located above the affected area. An incision is made on the lateral surface of the abdomen and the upper regions of the femoral region. A section of the aortic wall is selected, free from sclerotic accumulations, and sutured into it. artificial prosthesis vessel, which is made of neutral material and does not cause immune rejection. The other ends of the prosthesis are brought to the freed areas of the femoral arteries, sewn into their walls.

Shunting is performed unilaterally or bilaterally. sparing operational method Rob's method is recognized. The incision is made on the lateral surface of the abdomen, at the same time the nerves do not intersect. At such interference the patient can get up after a day, the risk of complications is minimal.

When a patient suffers from impotence that occurs with atherosclerosis, it is possible to eliminate the trouble by normalizing blood flow in the basin of the internal iliac arteries responsible for erection.

Possible Complications

Shunting of the arterial bed of the lower extremities in atherosclerosis is extremely complicated operation. The walls of the aorta are significantly changed, which greatly complicates the work of the surgeon. Change vascular wall may increase the risk of bleeding during surgery.

If atherosclerosis of the vessels is widespread, the patient often has serious problems with the heart and brain activity. Accompanying illnesses should be identified prior to surgery. During extensive operations, a stroke or myocardial infarction may occur.

There are cases when lymphostasis and swelling of soft tissues develop at the site of the incision, on the thigh. In this case, it is required to remove the liquid with a syringe.

Extremely rarely suppuration of the prosthesis can occur. This can lead to distant bleeding, the development of abscesses or sepsis. In order to prevent complications in surgical clinics, prostheses are used, the walls of which are impregnated with silver ions with a pronounced bactericidal effect.

Restoration of blood flow in arteries and veins - the only way save a limb from amputation when the leading arteries are affected. After the operation, further observation by the surgeon is necessary in order to prevent re-development vessel obstruction. To reduce the risk of developing vascular atherosclerosis, conservative treatment is prescribed to lower cholesterol and normalize metabolic processes.

Shunting of the vessels of the lower extremities is a surgical intervention that allows you to restore normal blood flow in the legs. It consists in creating a bypass (shunt) that excludes the affected area from the bloodstream. It is usually performed on the arteries of the lower extremities, but in some cases interventions on the veins are also indicated. The operation is performed exclusively by highly qualified and experienced surgeons in specialized clinics after the patients are fully examined and the need for such a procedure is confirmed.

There are two types of shunts used: biological and mechanical:

Biological or natural shunts made from automaterial - fabric own body. These shunts are strong enough to keep arterial blood flow in a small area. The native tissue of the body is widely used. Surgeons prefer autografts from the saphenous femoral vein, internal mammary artery, radial artery of the forearm. If the area of the lesion is large, and the condition of the vascular wall is unsatisfactory, synthetic implants are used.
Mechanical or synthetic shunts obtained from polymers. Synthetic vascular prostheses are used for bypassing large vessels that are under pressure from a powerful blood flow.

There are multi-storey shunts that are used in the presence of arteries with impaired patency at a considerable distance. The resulting short anastomoses act as connecting bridges with healthy areas.

Damage to the vessels of the lower extremities is observed more often than other peripheral ones. Shunting is prescribed for patients in the absence of therapeutic effect from conservative treatment. The structure and functions of the vessels of the legs pathologically change with aneurysm, arteritis, varicose veins, atherosclerosis, gangrene.

shunting of vessels of the lower extremities

Healthy arterial vessels with a smooth surface are affected, their walls become hard and brittle, calcified, covered cholesterol plaques, clogged with formed blood clots, narrowing the lumen and causing violation blood flow. If there is an obstruction to blood flow big sizes, appear prolonged pain in the calf muscles, the mobility of the limb decreases. Patients quickly get tired when walking, often stop and wait for the pain will pass. Progressive deformation of the vessels and complete occlusion of their lumen lead to impaired blood supply to the tissue, development of ischemia and necrosis. In the absence of the expected effect of drug therapy resort to surgery.

violation of the blood supply to the tissue and the development of gangrene

The defeat of the veins, in turn, is manifested by the weakness of the venous wall, the tortuosity of the veins, their expansion, the formation of blood clots, the development of trophic disorders. At risk of developing severe complications shunting may also be indicated for patients.

Vascular bypass surgery is currently performed mainly in those patients who are contraindicated for endovascular surgery. The shunt is attached to the vessel with one end above the lesion, and the other - below. This creates a bypass around the site blood vessel affected by the disease. Thanks to surgical intervention, it is possible to completely restore blood flow, avoid the development of gangrene and amputation of the limb.

Indications and contraindications

Bypass surgery of the lower extremities is not an easy procedure that must be performed according to strict indications. The operation is performed by angiosurgeons in the following cases:

Aneurysm of the peripheral arteries,
atherosclerotic lesion of the arteries,
obliterating endarteritis,
Beginning gangrene of the legs,
Phlebeurysm,
thrombosis and thrombophlebitis,
Inability to use endovascular and alternative techniques,
Lack of effect from drug treatment.

Vascular bypass surgery is usually not performed in the case of:

Opportunities for successful implementation
immobility of the patient,
Unsatisfactory general condition of the patient,
Diseases internal organs in the stage of decompensation.

Diagnostics

Specialists-angiosurgeons before bypass surgery interrogate the patient, find out the concomitant diseases he has, examine and refer him to a special diagnostic examination, including:

Clinical blood and urine tests for all major indicators.
Electrocardiography.
Magnetic resonance imaging, which allows you to view structural changes in blood vessels and determine the degree of their patency.
Computed tomography, which determines the degree of obturation of a blood vessel with a cholesterol plaque.
Duplex ultrasound, which assesses the state of blood flow and the vascular wall.
Angiography is a radiopaque study that allows you to determine the place of narrowing or blockage of the vessel on an x-ray.

After receiving the results of ultrasound and tomography, a preparatory period for the operation is assigned, during which patients are required to comply proper nutrition and take special drugs: "Aspirin" or "Cardiomagnyl" for the prevention of thrombosis, drugs from the group antibacterial agents and NSAIDs. Patients should stop eating 7-12 hours before surgery.

Surgery

Shunting of the vessels of the legs is a complex operation that requires high professionalism and certain work experience from the surgeon. The operation is performed under the general or local anesthesia, which is due medical indications and the general condition of the patients. Epidural anesthesia is considered to be the modern priority method of anesthesia, which significantly reduces the surgical risk.

Shunting is performed in violation of the patency of arterial and venous trunks, if their obstruction is more than 50% of the diameter. During the operation, a bypass is created using a transplant from the beginning of the obstacle to its end. Correctly performed operation ensures the restoration of blood flow in the affected vessels.

Stages of the operation:

Carry out layer-by-layer dissection of the skin and underlying tissues above and below the affected area.
Allocate the vessel, inspect and determine its suitability for the upcoming shunting.
The vessel is cut below the lesion, the shunt is sewn in, and then it is fixed from above.
Check the integrity of the implant.
After assessing the state of blood flow and pulsation, the arteries are sutured deep tissues and skin.

There are several options for shunting. The choice of each is determined by the localization of the affected area. Immediately after the operation, patients are put on an oxygen mask and injected intravenously with painkillers.

The first two days after surgery, patients are shown bed rest. Patients are then allowed to walk around the room and corridor. Cold compresses, set for 20 minutes, will help relieve pain and reduce swelling of injured tissues during the first day. All patients are advised to wear compression stockings and socks to prevent blood clots. An incentive spirometer should be used to improve lung function. Doctors inspect the incisions daily for possible infection. Within 10 days after the operation, specialists conduct dynamic monitoring of the patient, examining the indicators of the main vital functions organism.

Vascular shunting does not eliminate etiological factor pathology, but only facilitates its course and the condition of patients. Complex treatment the underlying disease includes not only surgery, but also lifestyle changes that prevent further development pathological process.

Postoperative period

The patient's body recovers relatively quickly after surgery. On the seventh day, surgeons remove the stitches, evaluate general state the patient and discharge him from the hospital for 10-14 days.

Rules to be followed in the postoperative period:

Follow a diet and avoid foods containing cholesterol and contributing to weight gain.
Take drugs that prevent thrombosis and lower blood cholesterol levels.
Work with a physiotherapist.
Walk, daily increasing the distance.
Fix in an elevated position of the limb during sleep.
Carry out hygienic treatment of postoperative wounds.
Perform simple physical exercises improving blood circulation in the legs.
Normalize body weight.
Periodically take blood tests to determine platelets and cholesterol.
Give up smoking and alcohol.
Treat comorbidities.
Follow the recommendations of angiosurgeons.
If you experience problems at the site of the operation, contact your doctor immediately.

In patients, the number and size of incisions on the legs depend on the number of shunts and the extent of the lesion. After surgery for ankle joints edema often occurs. Patients feel unpleasant burning sensation in places of withdrawal of veins. This feeling becomes especially acute when standing and at night.

After vascular bypass, the restoration of limb function occurs within two months, and the general condition of the patient improves almost immediately: the pain in the leg decreases or disappears, it gradually resumes physical activity. To speed up this process and restore strength to the muscles, the patient should make an effort and develop them.

Duration full life after vascular bypass surgery varies and depends on the patient's age, gender, presence of bad habits and concomitant diseases, compliance with the doctor's recommendations. Usually, patients undergoing surgery suffer from a severe form of vascular atherosclerosis. Their death in most cases occurs from ischemia of the myocardium or brain tissue (heart attack, stroke). If shunting of the vessels of the legs turns out to be unsuccessful operations, patients are threatened with amputation of the limb and death against the background of hypodynamia.

Complications

Complications that may occur after leg vascular bypass surgery:

Bleeding,
thrombosis of blood vessels,
secondary infection,
seam failure,
Pulmonary embolism,
Allergy to drugs
Acute coronary and cerebral insufficiency,
Heart attack,
Incomplete patency of the shunt,
Poor wound healing
Fatal outcome.

Carrying out antiseptic and aseptic measures makes it possible to exclude the development of such problems.

There are also complications that occur not after the operation, but during it. The most common intraoperative complication is the isolation of a vessel unsuitable for shunting. To prevent such a phenomenon, it is necessary to carry out preoperative diagnostics in a qualitative and detailed manner.

Such complications most often occur in individuals at risk and having the following problems:

Hypertension,
overweight,
hypercholesterolemia,
hypodynamia,
COPD
Diabetes,
kidney disease,
Heart failure,
Tobacco smoking.

After surgery, pain and numbness in the legs become less pronounced. Symptoms of the disease may resume after some time, due to the spread of the pathological process to neighboring arteries and veins. Vascular bypass does not cure atherosclerosis and varicose veins and does not eliminate the cause of vascular damage.

Prevention

Shunts can usually function normally for 5 years if taken care of regularly. medical examinations and take measures to prevent thrombosis.

Fight bad habits
Normalize body weight
Watch your diet, excluding high-calorie and fatty foods,
Support physical activity at the optimum level
Take drugs that prevent the development of thrombosis "Aspirin Cardio", "Trombo Ass", "Cardiomagnyl",
Take funds for atherosclerosis - Lovastatin, Atorvastatin, Atromidin, Clofibrin,
Visit your vascular surgeon regularly.

Arterial shunting is currently performed more often than venous bypass, due to the highest prevalence of arterial pathology. This operation is often the only way to deal with severe manifestations of arterial insufficiency. Surgical intervention significantly improves the quality of life of patients and prevents the development of gangrene of the lower extremities.

Video: lecture on atherosclerosis of the NK, its treatment and operations on the arteries

Diseases of the peripheral arteries are caused by the formation of atherosclerotic plaques in them. In many people, the disease does not manifest itself and does not require special treatment apart from eliminating risk factors, primarily smoking. When the obstruction to blood flow becomes greater, there are prolonged pain, decreased mobility. AT severe cases limb amputation required. For patients with severe ischemia, surgical methods for improving blood flow are considered - shunting of the vessels of the lower extremities or minimally invasive interventions (angioplasty and stenting). They allow you to normalize blood flow to the limb, relieve pain, restore mobility, prevent amputation and improve the quality of life.

Read in this article

Bypass indications

For patients in whom angioplasty cannot be performed, leg grafting is very effective procedure. During the operation, surgeons create an alternative blood flow path that bypasses the blockage of the artery, which allows you to restore the blood supply to the lower leg and foot.

Surgery is performed when medical treatment fails the following diseases:

, caused by a cholesterol plaque;
- narrowing of the lumen of the arteries due to inflammation of their walls.

Vascular diseases that are an indication for lower extremity vascular bypass surgery

Shunting is also performed in case of severe arterial aneurysm with the threat of its rupture and malnutrition of the tissues. It often allows you to save a limb with severe pain and the risk of gangrene.

Intervention Options

Bypass options are named depending on the connected vessels:

The connection of the arteries is carried out using a shunt. This may be the patient's own vessel - the saphenous vein of the thigh. If its condition is not good enough, or it has a short length, or in case of connection of large arteries, synthetic grafts are used.

Assessment of the condition before the operation

The doctor asks the patient in detail about the complaints, the time of their occurrence, concomitant diseases. He conducts a thorough examination of the legs, determines skin temperature, skin color, pulsation of peripheral arteries, reveals sensory disturbances and other objective signs of the disease.

Additionally, the following diagnostic tests are used:

A blood test is performed to determine the level of cholesterol, blood sugar and other indicators. Doctors also look for signs of inflammation, which may be causing narrowing of the arteries.

Methodology

Shunting of the vessels of the legs is performed under general anesthesia. In the femoropopliteal or femorotibial approach, the surgeon makes a skin incision in the upper thigh to expose the artery above the blockage. In addition, an incision is made under the knee or on the lower leg below the site of arterial thrombosis. The artery is closed with clamps.

When using the patient's own vein, the surgeon removes it from the front of the thigh. If the vessel is not suitable for transplantation, a tubular synthetic prosthesis is used. The surgeon connects the edges of the arteries and the graft using a microsurgical technique. The clamps are removed and blood flow through the new pathway is monitored to ensure that the bypass is functioning properly.

In these types of operations, the patient's own vessel is preferable because it retains its normal lumen longer and does not thrombose.

Aortobifemoral bypass surgery is performed in much the same way, but requires incisions in the lower abdomen and groin. lower abdominal aorta large vessel, therefore, the saphenous vein is not used, but a synthetic graft is used.

Immediately after the operation, anticoagulants are prescribed to prevent blood clotting in the transplant.

rehabilitation period

After shunting, the patient is observed for an hour in the postoperative ward, where they monitor blood pressure, pulse, oxygen content in the blood, and others. important indicators. Regularly evaluate the state of blood flow.

Subsequently, the patient is transferred to surgery department where he is regularly examined and bandaged. The hospital stay for femoropopliteal and femorotibial bypass surgery is usually several days. These patients can start walking on the day of surgery.

With aorto-bifemoral bypass surgery, the patient stays in the hospital for about a week. During the first 2 days, he must observe bed rest.

After discharge, you should walk more so that blood flow is fully restored. During rest, you need to raise your legs on the pillow. It is not uncommon for there to be a slight swelling associated with the removal of the saphenous vein. It is not dangerous and passes on its own in 1-2 months.

After the operation, it is necessary to refrain from smoking. As directed by your doctor, you should take aspirin and cholesterol-lowering medications. It is imperative to treat comorbidities - atherosclerosis, otherwise the shunt will soon clot again.

Decreased arterial lumen often extends over long distances, so long incisions are often needed. Wound healing problems occur in 20% of patients.

If they are mild, antibiotics should be used at home and dressings should be performed regularly. In case of serious complications, repeated hospitalization is required.

To minimize these problems, careful observation of the surgical technique and quality postoperative care. In this case, the service life of an autovenous graft in most patients is 5 years or more. To assess the state of blood flow, regular medical supervision and performance are necessary.

Contraindications

Vascular bypass surgery is a serious surgical intervention. It may be contraindicated in patients with high risk cardiovascular complications:

high arterial pressure, poorly treatable;
severe heart failure with shortness of breath and edema at rest;
frequent attacks of angina pectoris;
heart aneurysm;
severe violations heart rate- , and others.

The operation may be delayed if high level blood sugar and severe course diabetes, infectious diseases and skin lesions.

Complications

Like any surgical intervention, bypass surgery can have various complications, their frequency reaches 2%:

formation of a thrombus in a venous graft;
an allergic reaction to an anesthetic drug;
embolism of the vessels of the heart, lungs or brain with the development of a heart attack or stroke;
promotion or a sharp decline blood pressure;
wound infection;
bleeding from a wound;
sexual disorders in aorto-bifemoral shunting.

Patients with atherosclerosis of the vessels of the legs often suffer from concomitant heart diseases, so a thorough examination and assessment of the risk of intervention is necessary before surgery. Before and after the procedure, it is necessary to take aspirin and drugs that lower cholesterol and blood pressure.

Another group of complications is associated with the limb and includes insufficient patency of the anastomosis and poor healing wounds.

In general, the operation is successful in 90-95% of cases. risk and long-term effects interventions are associated with two main factors:

graft material (preference is given to own vein);
the state of the arteries of the lower leg, to which the anastomosis is attached.

After shunting and postoperative recovery relieves pain, improves the ability to move. It is often possible to delay the transition of the disease to severe form and limb amputation. For many patients with severe peripheral arterial disease, bypass surgery is the most effective and reliable solution.

Indications and contraindications

Bypass surgery of the lower extremities is not an easy procedure that must be performed according to strict indications. The operation is performed by angiosurgeons in the following cases:

Aneurysm of the peripheral arteries,
atherosclerotic lesion of the arteries,
obliterating endarteritis,
Beginning gangrene of the legs,
Phlebeurysm,
thrombosis and thrombophlebitis,
Inability to use endovascular and alternative techniques,
Lack of effect from drug treatment.

Vascular bypass surgery is usually not performed in the case of:

Contains chestnut extract. It strengthens blood vessels, preventing the formation of varicose veins. They should be used for circulatory disorders in the lower extremities and anal varicose veins, as well as in case of vascular collapse and permeability. If you're swelling on your foot, it shouldn't be related to venous disease. Winnie can be a dysfunction in lymphatic system caused by damage to the valve in the lymphatic vessels. Then the lymphatic drainage from the legs is inhibited. Feet swell in the ankle area because that is where the lump accumulates.

Opportunities for successful implementation
immobility of the patient,
Unsatisfactory general condition of the patient,
Diseases of internal organs in the stage of decompensation.

Diagnostics

Prior to shunting, angiosurgeons interrogate the patient, find out the concomitant diseases he has, examine and refer him for a special diagnostic examination, including:

To prevent this, use drainage and lymphatic massage. It also helps to stand up with your feet up and limit the amount of salt. Another possible cause of leg swelling is various conditions, which contribute to the expansion of veins. Don't forget to see what real reason leg swelling.

Varicose veins are a problem that has not been known for many years. These superficial or visible veins spiders are not dangerous. On the contrary, perhaps even varicose veins veins. Certain types of physical activity can exacerbate circulatory problems. These include aerobics, tennis, table tennis and horseback riding. They are recommended: cycling, running, swimming, walking, yoga.

Clinical blood and urine tests for all major indicators.
Electrocardiography.
Magnetic resonance imaging, which allows you to view structural changes in blood vessels and determine the degree of their patency.
Computed tomography, which determines the degree of obturation of a blood vessel with a cholesterol plaque.
Duplex ultrasound, which assesses the state of blood flow and the vascular wall.
Angiography is a radiopaque study that allows you to determine the place of narrowing or blockage of the vessel on an x-ray.

After receiving the results of ultrasound and tomography, a preparatory period for the operation is prescribed, during which patients are required to follow proper nutrition and take special drugs: Aspirin or Cardiomagnyl for the prevention of thrombosis, drugs from the group of antibacterial agents and NSAIDs. Patients should stop eating 7-12 hours before surgery.

White is less favorable for blood vessels because it contains more harmful compounds. Promotes varicose veins tight clothes. Especially unfavorable are thighs in jeans, anti-cellulite tights, socks with a knee, self-supporting stockings.

You can't go overboard with hard liquor like cognac or liqueurs and spicy spices, which can also affect vein dilation. The course of the disease is asymptomatic for a long time, symptoms develop slowly and appear late. Usually, when the patient goes to the doctor, it is pain, quite characteristic, because it occurs when walking. Occurs below the site of stenosis. Most often this is calf pain, although it can be, for example, pain in the hips. This symptom is called intermittent lameness. The patient feels pain after walking a certain distance and after a few minutes of rest it can continue.

Surgery

Shunting of the vessels of the legs is a complex operation that requires high professionalism and certain work experience from the surgeon. The operation is performed under general or local anesthesia, which is due to medical indications and the general condition of the patients. Epidural anesthesia is considered to be the modern priority method of anesthesia, which significantly reduces the surgical risk.

The length of this distance indirectly indicates the severity of the disease. However, each patient has a different, and for some, a painless transition to 200 meters, for others, a distance of 500 meters disrupts daily functioning. This should be taken into account when deciding on surgical intervention, since any action to improve blood supply entails the risk of worsening blood supply in another vascular segment.

When visiting a doctor, it is very important to assess whether this is true, and not, for example, a degenerative disease of the spine is the cause of pain in the limbs. At this stage of the disease it is very important: stop smoking, improve lipid profile, regulate hypertension and moderate exercise , Walking exercise, in which the body produces collateral circulation, allowing blood to pass through the narrowed artery and reach the tissues with new vessels. This helps to lengthen the gap. Vasodilators, often taken by patients, may affect the duration of the chlamydial distance and reduce symptoms, but have no proven effect on inhibiting the progression of the disease.

More importantly in pharmacological treatment appears to take prophylactic doses of aspirin to reduce mortality due to cardiovascular events. Another problem is the coexistence of diabetes. In these patients, the course of the disease is extremely insidious and the treatment less effective is diabetes, in addition to accelerating atherosclerotic lesions in large arteries, leads to minor damage to the vessels, which prevents such an important collateral circulation. Therefore, it is important to effectively treat hypoglycemic treatment.

As the disease progresses, there is pain in the resting limbs, often waking the patient at night and then ischemic lesions such as ulcers and necrosis. In this case, surgical intervention becomes inevitable. The main goal of surgical treatment is to restore blood circulation to the ischemic limb. Sometimes, although rarely, it is enough to break and open the artery, and then clean it. Most often, however, vascular transplantation is required, bypassing arterial narrowing or blockage of the artery.

Stages of the operation:

Carry out layer-by-layer dissection of the skin and underlying tissues above and below the affected area.
Allocate the vessel, inspect and determine its suitability for the upcoming shunting.
The vessel is cut below the lesion, the shunt is sewn in, and then it is fixed from above.
Check the integrity of the implant.
After assessing the state of blood flow and pulsation of the artery, deep tissues and skin are sutured.

Depending on the arteries located on atherosclerotic lesions, aorto-femoral, femoral-knee or even arterial constrictions are performed. There are also so-called Non-anatomical grafts such as the femoral-femoral region where pubic symphysis performed from one superficial femoral artery to another. The transplant can be performed from a vein taken from the patient or if the vein cannot be removed from a synthetic material. After surgery, in order to maintain the patency of the vascular bridges, platelet therapy is very important.

In addition to aspirin intake at the cardiac dose, the use of a second antiplatelet agent is also recommended. The patient is required to check regularly after the operation. In case of any symptoms sudden deterioration blood supply to the operated limb, it is very important to contact the vascular surgeon as soon as possible. The earlier vascular closure is detected, the more likely treatment.

Continuous technological advances and improved equipment have made it possible in some cases to replace classical angioplasty techniques. All more patients with chronic ischemia can be treated with endovascular methods. It's less invasive methods, after which patients return to daily activities faster and are most often performed under local anesthesia, which is very important for older patients with other diseases and recurring ones. The disadvantage of endovascular surgery is the possibility of dissection or damage to the artery or separation of the inner membrane of the vessel, creating conditions for thrombosis.

Vascular shunting does not eliminate the etiological factor of the pathology, but only facilitates its course and the condition of patients. Comprehensive treatment of the underlying disease includes not only surgery, but also lifestyle changes that prevent the further development of the pathological process.

Postoperative period

The patient's body recovers relatively quickly after surgery. On the seventh day, surgeons remove the stitches, assess the general condition of the patient and discharge him from the hospital on days 10-14.

Rules to be followed in the postoperative period:

Follow a diet and avoid foods containing cholesterol and contributing to weight gain.
Take drugs that prevent thrombosis and lower blood cholesterol levels.
Work with a physiotherapist.
Walk, daily increasing the distance.
Fix in an elevated position of the limb during sleep.
Carry out hygienic treatment of postoperative wounds.
Perform simple physical exercisesimproving blood circulation in the legs.
Normalize body weight.
Periodically take blood tests to determine platelets and cholesterol.
Give up smoking and alcohol.
Treat comorbidities.
Follow the recommendations of angiosurgeons.
If you experience problems at the site of the operation, contact your doctor immediately.

In patients, the number and size of incisions on the legs depend on the number of shunts and the extent of the lesion. Swelling often occurs after ankle surgery. Patients feel an unpleasant burning sensation in the places where the veins are taken. This feeling becomes especially acute when standing and at night.

After vascular bypass, the restoration of limb function occurs within two months, and the general condition of the patient improves almost immediately: the pain in the leg decreases or disappears, its motor activity gradually resumes. To speed up this process and restore strength to the muscles, the patient should make efforts and develop them.

The duration of a full life after vascular bypass surgery varies and depends on the patient's age, gender, the presence of bad habits and concomitant diseases, and compliance with the doctor's recommendations. Usually, patients undergoing surgery suffer from a severe form of vascular atherosclerosis. Their death in most cases occurs from ischemia of the myocardium or brain tissue (heart attack, stroke). If shunting of the vessels of the legs turns out to be unsuccessful operations, patients are threatened with amputation of the limb and death against the background of hypodynamia.

Complications

Complications that may occur after leg vascular bypass surgery:

Bleeding,
thrombosis of blood vessels,
secondary infection,
seam failure,
Pulmonary embolism,
Allergy to drugs
Acute coronary and cerebral insufficiency,
Heart attack,
Incomplete patency of the shunt,
Poor wound healing
Fatal outcome.

Carrying out antiseptic and aseptic measures makes it possible to exclude the development of such problems.

Such complications most often occur in individuals at risk and having the following problems:

Hypertension,
overweight,
hypercholesterolemia,
hypodynamia,
COPD
Diabetes,
kidney disease,
Heart failure,
Tobacco smoking.

Prevention

Shunts can usually function normally for 5 years with regular medical check-ups and thrombosis prevention measures.

Fight bad habits
Normalize body weight
Watch your diet, excluding high-calorie and fatty foods,
Maintain optimal physical activity
Take drugs that prevent the development of thrombosis "Aspirin Cardio", "Trombo Ass", "Cardiomagnyl",
Take funds for atherosclerosis - Lovastatin, Atorvastatin, Atromidin, Clofibrin,
Visit your vascular surgeon regularly.

Arterial shunting is currently performed more often than venous bypass, due to the highest prevalence of arterial pathology. This operation often becomes the only way to deal with severe manifestations of arterial insufficiency. Surgical intervention significantly improves the quality of life of patients and prevents the development of gangrene of the lower extremities.

Video: lecture on atherosclerosis of the NK, its treatment and operations on the arteries

Treatment is conservative and surgical. Often, surgical methods include removal of a thrombus and angioplasty of the lower extremities. If the disease is already in an advanced stage, after the death of soft tissues and the development of a gangrenous process, the surgeon performs surgical excision of necrotic areas of soft tissues, then the excised areas are covered with a skin flap.

If atherosclerosis of the lower extremities has passed into an advanced stage, conservative treatment is no longer effective, an operation is chosen that can maximize the patient's quality of life after treatment, his state of health.

Balloon angioplasty

Nowadays, intravascular surgical treatment is the method of choice for atherosclerosis. Surgical interventions that allow restoring blood flow to the lower extremities significantly reduce the number of amputations by several orders of magnitude. Plastic surgery of the vessels of the lower extremities is aimed at restoring the patency of the arteries of the lower extremities and restoring the lumen of the stenotic artery.

If the therapeutic effect could not be achieved, a frame made of a special metal is introduced into the obstruction zone. Its purpose will be to maintain the normal diameter of the vessel and ensure its patency.

In patients diagnosed with Leriche's syndrome, endovascular operations can improve the state of blood flow in the vessels of the lower extremities.

Vascular plasty and stenting, carried out in the line of the superficial femoral artery, eliminates the phenomena of chronic vascular insufficiency that has arisen after blockage of the lumen of the artery by a thrombus. A number of leading surgical clinics prefer this type of intervention.

In a number of clinics, the described surgical treatment is widely used to restore the patency of the popliteal arteries. The method of treatment of atherosclerosis has been tested by surgeons relatively recently. Previously, stenting of the popliteal vessels caused frequent side effects in the form of stent breakage or its displacement when the lower limb was bent at the knee joint. At present, stents resistant to strong kinks have found application. Scientific developments are being actively carried out in the field of creating stents that can dissolve over time.

Complex surgical treatment is carried out using balloons with drug coatings. With this method of surgical intervention, the balloon is impregnated with medicinal substances, which, after the introduction of the balloon into the vascular bed, are absorbed into the vascular wall, preventing further development and pathological growth of the endothelial membrane.

What are the advantages of balloon plastic surgery

The results of balloon plastics

The normal passage of blood through the vessels after plastic surgery in the iliac arteries persists for five years from the time of surgery in the vast majority of operated patients.

Follow-up data of observation of patients allow the surgeon to recognize the repeated deterioration of the condition in a timely manner, if necessary, to treat the condition. To do this, the patient undergoes ultrasound dopplerography twice a year and a computed tomogram once a year. Provided that the patient is under dispensary observation and timely treatment is prescribed, the function of walking in a person is preserved throughout life.

Aortofemoral bypass

The main indications for the operation will be the conditions:

Occlusion in the line of the abdominal aorta with an increase in arterial chronic insufficiency.
Blockage in the basin of the iliac arteries with the condition that it is impossible to carry out endovascular plasty.
Aneurysm of the wall of the abdominal aorta in the infrarenal region.

Aorto-femoral bypass is now considered a common and radical way to prevent severe ischemia and limb amputation. According to statistical studies, the loss of limbs among patients with vascular lesions takes up to one-fifth of pathological conditions. In the case of a well-performed operation in the abdominal aorta, the risk of amputation is reduced to 3%.

Intervention technique

The meaning of surgical intervention for atherosclerosis is to isolate the part of the aorta located above the affected area. An incision is made on the lateral surface of the abdomen and the upper regions of the femoral region. A section of the aortic wall free of sclerotic accumulations is selected, an artificial vessel prosthesis is sutured into it, which is made of a neutral material and does not cause immune rejection. The other ends of the prosthesis are brought to the freed areas of the femoral arteries, sewn into their walls.

Shunting is performed unilaterally or bilaterally. The Rob method is recognized as a gentle surgical method. The incision is made on the lateral surface of the abdomen, at the same time the nerves do not intersect. With such an intervention, the patient can get up a day later, the risk of complications is minimal.

Possible Complications

Shunting of the arterial bed of the lower extremities in atherosclerosis is an extremely complex operation. The walls of the aorta are significantly changed, which greatly complicates the work of the surgeon. Changes in the vascular wall may lead to the risk of bleeding during surgery.

If atherosclerosis of the vessels is widespread, the patient often has serious problems with cardiac and brain activity. Comorbidities should be identified prior to surgery. During extensive operations, a stroke or myocardial infarction may occur.

There are cases when lymphostasis and swelling of soft tissues develop at the site of the incision, on the thigh. In this case, it is required to remove the liquid with a syringe.

Restoring blood flow in the arteries and veins is the only way to save a limb from amputation when the leading arteries are affected. After the operation, further observation by the surgeon is necessary in order to prevent the recurrence of vessel obstruction. To reduce the risk of developing vascular atherosclerosis, conservative treatment is prescribed to lower cholesterol and normalize metabolic processes.

Rupture, narrowing, or blockage of blood vessels (most often arteries) can be life-threatening or cause disability. Blockage of the arteries can occur due to atherosclerosis (narrowing of the lumen of the vessel) or for any other reasons (for example, due to thrombosis, embolism, etc.). However, modern vascular surgery has reached such heights that the affected blood vessel can be replaced with an artificial one or taken from a donor. In case of damage to the abdominal artery or artery of the leg, it becomes necessary to use prostheses. Prostheses can be made from different materials, for example, from plastic.

Implantation of an artificial vessel

The complexity of such an operation most depends on the location of the affected artery. For example, surgery to replace a large branch of the abdominal artery is very complex and takes several hours. Meanwhile, lower limb artery replacement surgery is more simple. In order for the surgeon to determine the feasibility and extent of the operation, the place and degree of narrowing of the blood passage, as well as the length of the affected area, before the start of implantation, contrast agent and do x-rays. However, there are cases when, due to the nature of the damage to the artery, a prosthetic operation is not possible. In addition, the results of the operation to implant a blood vessel prosthesis are unsatisfactory, therefore, it is often refused.

Shunt placement

During this operation, unforeseen complications may arise even after careful consideration of all circumstances. Therefore, attempts are made to bypass the affected area of the artery by imposing the so-called shunt. In this case, the ends of the prosthesis are sewn into the healthy part of the vessel, one is above the affected area, and the other is below. Atherosclerosis affects all arteries to some extent. If during the operation the doctor ascertains the thinning of the walls of the arteries, then surgical technique arterial prosthetics is much more complicated.

If the operation of applying a shunt to bypass the narrowed portion of the vessel was successful, then in order to avoid blockage of the prosthesis by a thrombus, drugs are prescribed that reduce blood clotting. Of course, these drugs do not guarantee 100% protection against re-occlusion, but they can reduce its likelihood.

In what cases is the implantation of an artificial vessel performed?

Atherosclerotic lesions of the arteries can be varying degrees expressiveness. As the disease progresses, edema arterial walls and damage to their inner layer. Then calcification of the vessel begins. The lumen of the blood passage gradually decreases and, in the end, it narrows so much that it makes it difficult for the blood to move. For example, due to lack arterial circulation limbs, patients experience intermittent claudication, when convulsive pains in the calf muscles are felt when walking. Then the pains appear at rest, during sleep. The treatment consists in the implantation of an artificial vessel. Implantation of the prosthesis is also indicated for expansion of the abdominal aorta. Otherwise, the aneurysm may rupture, leading to significant blood loss.

Is such an operation dangerous?

The most difficult are operations to replace the blood vessels of the abdominal aorta. However, complications can also arise during prosthetics of the vessels of the lower extremity. The so-called emergency operations performed with a sudden blockage of the artery of the lower limb.

Even if the operation to implant an artificial blood vessel was successful, this does not mean that re-occlusion of the blood vessel will not occur. Therefore, after surgery, the patient must necessarily take medication. In order to reduce the risk of a blood clot, it is necessary to eliminate risk factors and conduct active image life.