Operations for occlusion of the vessels of the lower extremities. Preparation for the operation. Eversion carotid endarterectomy

Circulation in the legs is impaired different reasons, in particular due to the formation of atherosclerotic plaques in the vessels. Postponing treatment is fraught with serious consequences, up to amputation. If a drug therapy is not effective enough, doctors recommend patients a minimally invasive procedure - vascular stenting lower extremities.

The operation to install a stent involves the introduction of an expanding device that preserves the natural lumen of the vessel.

Indications for surgery

One of the most common pathologies of the lower extremities is. When atherosclerosis appears, the throughput vessels, that is, stenosis occurs (their lumen decreases). Due to problems with blood circulation, a person is faced with unpleasant manifestations. If the patient does nothing, the disease will lead to tissue necrosis and blood poisoning.

Blood circulation in the legs is severely disturbed in diabetes mellitus, which is expressed in the appearance of ulcers on skin surfaces. If a ulcer formations if not treated in time, the patient will lose a limb.

Any pain in the legs should serve as a reason for applying for an examination. While the disease is initial stage, it will be possible to cope with drug therapy.

Indications for stenting of the arteries of the lower extremities are as follows:

limb dysfunction.

There are also contraindications to stenting:

too small diameter of the affected vessel (vessels with a diameter of at least 2.5 mm are suitable for stenting);
diffuse stenosis (when too much of the vessel is affected);
respiratory and renal failure;
blood clotting disorders;
excessive sensitivity to iodine (substance used for contrast).

Timely surgical intervention will avoid amputation.

Execution technique

Stenting of the lower extremities takes place in several stages:

Local anesthesia is used in the area where the puncture of the vessel is planned.
Most often, stenting of the femoral arteries is performed.
After puncturing the vessel, a special catheter is inserted, which has a balloon at the end. The surgeon guides the catheter along the artery to the site where there is a critical narrowing. As a result of inflating the balloon, the lumen of the artery is restored.

Another catheter is used, with the help of which a compressed stent is led to the affected area. Subsequently, he will straighten out, fixing on the walls of the vessel. The stent is in the form of a mesh tube.
The doctor observes what is happening with the help of x-ray imaging.
On the last step all inserted objects are removed, except for the stent. To prevent hemorrhage, the hole is clamped for 10-15 minutes.

Important! If the deformity is too long, several stents are placed during the operation.

Stenting can be performed not only on the femoral artery. In many, the popliteal vessels suffer from atherosclerotic lesions.

Stenting of the vessels of the legs, depending on the degree of the disease, lasts from one to three hours, while the patient does not feel any painful discomfort. Thanks to local anesthesia, a person can tell doctors about his own feelings.

Different types of stents are used to increase the vascular lumen. Products are:

simple metal;
with a special coating that slowly releases the drug into the blood.

Advantages of the method

The benefits of stenting include:

Minimally invasive. Compared to other surgical methods that require making incisions in a specific area, stenting requires only a puncture in order to subsequently insert a catheter.
Local anesthesia eliminates the risks associated with general anesthesia which is especially important for the elderly.
Short recovery period. The patient usually leaves the hospital the next day after surgery.
Minimal chance of complications.

Training

Before stenting the veins of the lower extremities, the patient must prepare in a certain way. If there are indications for surgical treatment, he is sent for the passage of:

general analysis of urine and blood;
coagulograms;
biochemical blood test;

electrocardiograms;
fluorography;
ultrasonic dopplerography of vessels of the lower extremities;
angiography and other studies.

It is forbidden to eat and drink at least 12 hours before the operation. A week later, the doctor adjusts the intake medicines, and for two to three days prescribes antiplatelet agents.

Complications after surgery

With any surgical intervention, complications are not excluded. Stenting can result in:

deformation of the vascular wall or its rupture;
hemorrhage;
the formation of hematomas or tumors at the puncture site;
deterioration of kidney function;
restenosis (re-overgrowth of the lumen);
stent fracture.

These effects are quite rare.

Recovery period

Doctors warn that the installation of a stent will not cure the disease. The operation helps to eliminate only the consequences. AT postoperative period You will need to regularly pay attention to your health.

Rehabilitation includes:

Regular intake of drugs with antiplatelet action. Usually, medications must be taken for at least 3 months after surgery. The dosage and duration of the course are prescribed individually.
Compliance with a lipid-lowering diet. The patient should eat foods that reduce cholesterol.

Continuous monitoring of blood pressure. If the numbers are very high, you will need to change your lifestyle. Your doctor may prescribe medication to lower your blood pressure. Be sure to limit your salt intake.
The maximum elimination of factors that provoke the development of atherosclerosis. You need to normalize your weight, get rid of nicotine addiction Stop drinking alcohol and engage in moderate physical activity.

Price

Many factors affect the cost of the operation. Stenting is performed using expensive equipment. All necessary manipulations are carried out qualified specialists. In addition, the price depends on the material used. A drug-coated stent is much more expensive. An ordinary stent costs from 50 thousand rubles.

In different clinics similar treatment own price. The degree of complexity of the disease and the number of vessels that need to be operated are taken into account. In general, surgical intervention with the use of stents costs patients at least 80 thousand rubles.

It is not worth saving on your health, especially since the operation helps most patients return to a normal lifestyle. The consequences of impaired blood flow can be quite dangerous. There are cases when, due to damage to the lower extremities, the patient dies. The effectiveness of stenting fully justifies its cost.

Thanks to stenting, patients can get rid of unpleasant discomfort in the legs. However, without following all the doctor's recommendations in rehabilitation period vascular stenosis is possible. If you notice negative changes in well-being in a timely manner and contact specialists, it will be possible to prevent possible complications.

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 the obstruction to blood flow is large, there are 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 to 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, surgery is resorted to.

Patients, however, are reluctant to do so, often with great delay. The disadvantage of this method of removing varicose veins is the long recovery after surgery. Unlike laser methods or sclerotherapy, when you quickly return home, the operation requires a long stay in the hospital, and then dismissal at least for two weeks. Normal activity may resume only after a few weeks. But so far, only such an operation has been fully reimbursed by the National Health Fund.

Other treatments may be provided in private medical institutions e.g. in a private practice or clinic. You can do this for a fee or a fraction of the cost. Untreated varicose veins can lead to serious complications. Stasis is often the cause venous insufficiency. The skin in this place turns red, becomes tense and painful. When it is damaged, ulcers form and are difficult to heal. In such an advanced stage of varicose veins, when there is a risk of developing venous inflammation, your doctor orders specialized medicines.

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.

However, it should be borne in mind that the therapy lasts for a long time, and the patient must take precautions after treatment to avoid inflammation of the veins. If you're just going on vacation, check out the latest expert advice. It turns out that the best holiday for you will be in the mountains. Regular steps and descents improve blood circulation in the legs.

However, if you prefer the sea, enjoy every opportunity to swim. Water acts as a massage, stimulating microcirculation. Systematic movement renders big influence both on the state of the blood vessels and on the blood circulation. Remember that when you are in the water, you weigh much less. It is easier for you to perform all the exercises, and your muscles are less tense than, for example, during a workout in the gym.

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.

It is best to swim in water whose temperature does not exceed 25 degrees Celsius. The heater will help expand the veins. Also avoid lying on the beach for a long time. Sunbathing contributes to the formation of varicose veins. In hot weather, cover your feet with a towel soaked in water or walking along the promenade for half an hour.

Anticoagulant preparations are best used simultaneously: orally and externally, at the site of symptoms. They are useful both in primary and late stage diseases. Most of them were created on the basis of chestnut extract of chestnut. Sometimes heparin is thinned by blood, arnica and menthol. Gels work against edema and anti-inflammatory, thicken veins, improve capillary endothelium. Lubricate your feet in the morning and evening.

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 internal organs in the stage of decompensation.

Diagnostics

Specialists-angiosurgeons before bypass surgery interview the patient, find out the concomitant diseases he has, examine and refer him to 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 look up what is the real cause of 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 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.

White is less favorable for blood vessels because it contains more harmful compounds. Tight clothing contributes to varicose veins. 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 - complicated operation requiring 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 kept in mind 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.

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.

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, 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.

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.

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 of the body.

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 the event of any symptoms of a sudden deterioration in the blood supply to the operated limb, it is very important to contact a 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. These are 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 further development 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. After surgery for ankle joints edema often occurs. 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, a general state 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 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 following 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,
Thromboembolism pulmonary artery,
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 with regular medical check-ups and thrombosis prevention measures.

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 combating 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 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 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 flexed 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 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 is maintained 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 the line of the 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 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 the heart 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.

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.

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 re-development vessel obstruction. To reduce the risk of developing atherosclerosis of the vessels, it is prescribed conservative treatment to lower cholesterol and normalize metabolic processes.

Vascular shunting 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 - tissue of one's 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 prostheses are used in shunting large vessels experiencing the pressure of a powerful flow of blood.

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 to patients in the absence of a 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 with cholesterol plaques, clogged with formed blood clots that narrow the lumen and cause blood flow disturbance. If the obstruction to blood flow is large, prolonged pain in the calf muscles appears, and the mobility of the limb decreases. Patients quickly get tired when walking, often stop and wait for the pain to 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, surgery is resorted to.

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 the risk of developing severe complications, patients may also be shown shunting.

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 area of the 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 of internal organs in the stage of decompensation.

Diagnostics

Prior to shunting, angiosurgeons interrogate the patient, find out his concomitant diseases, examine and refer him for 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 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.

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.

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.

Vascular shunting does not eliminate etiological factor 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

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. 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 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

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 to the greatest extent depends on the localization 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 take 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 lead an active lifestyle.

Operations on the heart and blood vessels are performed by such a branch of medicine as cardiac surgery.

With the help of cardiac surgeons, many vascular and cardiac diseases can be effectively treated, thereby significantly prolonging the life of the patient.

Operations on the heart and blood vessels can significantly improve general well-being sick.

They should be performed only after a thorough diagnosis and preparation of the patient.

It is very important to follow all the instructions of the specialist exactly.

Regardless of which disease was identified in a person, there are the following general indications for operations on the heart and blood vessels:

Rapid deterioration of the patient's condition and progression of the underlying disease of the heart or blood vessels.
The lack of positive dynamics from the use of traditional drug therapy, that is, when taking pills no longer helps a person to maintain his condition in a normal way.
The presence of acute signs of deterioration of the underlying myocardial disease, which cannot be eliminated by conventional analgesics or antispasmodics.
The neglect of the underlying disease, in which the patient hesitated to contact the doctor, which led to very severe signs illness.

These procedures are indicated for patients with heart defects (regardless of whether they are congenital or acquired). Moreover, with current technology this disease can be treated even in newborn babies, thereby providing them with a further healthy life.

Following frequent indication is myocardial ischemia. In this case, surgery may be required when the underlying disease is aggravated by a heart attack. In this condition, the sooner surgery is performed, the greater the chance that the person will survive.

A significant indication for the need for surgical intervention can be acute heart failure, which provokes abnormal contraction of the myocardial ventricles. At the same time, it is important that the patient prepares for the operation in advance (to avoid postoperative complications in the form of a blood clot).

Often surgery is required for myocardial valve disease, which was provoked by trauma or inflammatory process. Rarely, other causes contribute to its appearance.

A serious reason for the urgent intervention of surgeons is the diagnosis of narrowing of the coronary valve of the artery, as well as endocarditis of infectious origin.

Additional conditions that may require a person to have myocardial surgery include:

Severe aortic aneurysm, which may result from trauma or be congenital.
Rupture of the ventricle of the heart, because of which the blood flow was disturbed.
Different kinds arrhythmias that can be eliminated by inserting or replacing an already installed pacemaker. They are usually used for atrial fibrillation and bradycardia.
Diagnosis of an obstruction in the myocardium in the form of tamponade, due to which the heart cannot pump the required volume of blood normally. This condition can arise when viral infections, acute tuberculosis and myocardial infarction.
Acute deficiency left ventricular myocardium.

Cardiac surgery is not always necessary for the above indications. Each case is individual and only the attending physician can decide what is best for a particular patient - traditional drug therapy or a planned (urgent) operation.

In addition, it should be noted that heart surgery may be required in case of exacerbation of the underlying disease, as well as if the first surgical intervention did not give the expected results. In this case, the patient may need to repeat manipulation. Its cost and preparation features (diet, medication) depend on the complexity of the operation.

Surgical interventions can be practiced both on the open myocardium and on the closed one, when the heart and its cavity are not completely affected. The first type of operation involves cutting chest and connecting the patient to artificial respiration equipment.

During operations open type surgeons artificially stop the heart for a while, so that within a few hours they can perform the necessary surgical procedures on the organ. These interventions are considered very dangerous and traumatic, but they can be used to eliminate even very complex diseases myocardium.

Closed type operations are more secure. They are usually used to correct minor heart and vascular defects.

There are the following most common types of myocardial operations, which are most often practiced in cardiac surgery:

Installation of artificial valves.
Operations according to the method of Glenn and Ross.
Coronary artery bypass grafting and arterial stenting.
Ablation of radiofrequency type.

An operation called radiofrequency ablation is a low-traumatic procedure that can achieve significant improvements in heart failure and different types arrhythmias. She rarely calls side effects and well tolerated by patients.

RA is performed using special catheters that are inserted under X-ray control. The patient is then given local anesthesia. During this operation, a catheter is inserted into the organ and, thanks to electrical impulses, the normal heart rhythm is restored to the person.

The next type of surgery is prosthetic heart valves. This intervention is very often practiced, since such a pathology as myocardial valve insufficiency is extremely common.

It should be noted that in the event of a severe failure in heart rate patient, he may need to establish special device- a pacemaker. It is needed to normalize the rhythm of the heart.

When prosthetic heart valves can be used the following types of implants:

Mechanical prostheses that are made of metal or plastic. They serve for a very long time (several decades), but require permanent reception human blood thinners, because due to the introduction of a foreign object in the body, a tendency to form blood clots is actively developing.
Biological implants are made from animal tissues. They are very durable and do not require special preparations. Despite this, patients after a couple of decades often require a second operation.

Glenn and Ross operations are commonly used to treat children with birth defects myocardium. The essence of these interventions is to create a special connection for the pulmonary artery. After this operation, the child can live for a long time, with little or no need for maintenance therapy.

During the Ross operation, the patient is replaced by a diseased myocardial valve with a healthy one, which will be removed from his own pulmonary valve.

Cardiac bypass surgery: indications and conduct

Coronary artery bypass grafting is a surgical intervention on the heart, during which an additional vessel is sewn in order to restore the disturbed blood supply in the clogged blood arteries.

Cardiac bypass surgery is practiced in the case when the narrowed vessels of the patient are no longer amenable to drug treatment and blood cannot circulate normally to the heart, causing ischemic attacks.

A direct indication for cardiac bypass surgery is acute coronary aortic stenosis. Most often, a neglected form of atherosclerosis leads to its development, which contributes to clogging of blood vessels with cholesterol plaques.

Due to vasoconstriction, blood cannot circulate normally and deliver oxygen to myocardial cells. This leads to its defeat and the risk of a heart attack.

Today, heart vessel bypass surgery can be performed both on a beating heart and on an artificially stopped one. At the same time, it should be noted that if shunting is done on a working myocardium, then the likelihood of postoperative complications is much higher than when performing a procedure on a stopped myocardium.

The course of this operation consists in blocking the main aorta and implanting artificial vessels into the affected coronary arteries. Usually, a vessel in the leg is used for shunting. It is used as a biological implant.

Contraindications to this surgical intervention may be an existing pacemaker or an artificial valve in the heart, the functions of which may be impaired during such an operation. In general, the need for shunting is determined individually by the doctor for each individual patient, based on the diagnostic data and the patient's symptoms.

After bypass surgery, the recovery period is usually fast, especially if the patient does not have any complications after the procedure. Within a week after the operation, the patient must comply with bed rest. Until the stitches are removed, a person needs to do wound dressings daily.

After ten days, a person can get out of bed and begin to perform simple movements of physiotherapy exercises in order to restore the body.

After the wound has completely healed, the patient is advised to go swimming and walk regularly in the fresh air.

It should be noted that the wound after shunting is not sewn with threads, but with special metal staples.. This is justified by the fact that the dissection falls on a large bone, so it needs to grow together as carefully as possible and ensure peace.

To make it easier for a person to move around after the operation, he is allowed to use special medical support bandages. They look like a corset and perfectly support the seams.

After surgery, due to blood loss, a person may experience anemia, which will be accompanied by weakness and dizziness. To eliminate this condition, the patient is advised to eat right and enrich his diet with beets, nuts, apples and other fruits.

To reduce the likelihood of re-constriction of blood vessels, alcohol, fatty and fried foods should be completely excluded from the menu.

The operation of stenting of the vessels of the heart: indications and features of the conduct

Arterial stenting is a low-traumatic angioplasty procedure, which involves the imposition of a stent into the lumen of the affected vessels.

The stent itself is similar to a conventional spring. It is injected into the vessel after it has been artificially dilated.

Indications for cardiac stenting surgery are:

coronary artery disease ( ischemic disease heart), which leads to circulatory disorders and oxygen starvation myocardium.
Myocardial infarction.
Clogging of blood vessels with cholesterol plaques, which lead to a narrowing of their lumen.

Additional contraindications to this procedure are the patient's individual intolerance to iodine, which is invariably used during stenting, as well as the case when the total size of the diseased artery is less than 2.5 mm (in this case, the surgeon simply cannot install the stent).

An operation is performed to stent the vessels of the heart by introducing a special balloon that will expand the lumen of the diseased vessel. Further, a filter is installed in this place, which prevents subsequent blood clots and stroke.

After that, a stent is inserted into the vessel; it will support the vessel from narrowing, serving as a certain frame.

The surgeon monitors the entire course of the operation through a monitor. At the same time, he will see the stent and the vessel well, since even at the beginning of the procedure, the patient is injected with an iodine solution, which will reflect all the actions of the surgeon.

The advantage of stenting is that this operation It has low risk the development of complications. Moreover, it is performed under local anesthesia and does not require a long period of hospitalization.

After stenting certain time the patient must comply with bed rest (usually for a week). After that, if there are no complications, the person is allowed to go home.

It is very important to exercise regularly after this operation. physical therapy and do the exercises. At the same time, it is worth controlling your condition and not allowing physical overwork.

Every two weeks after the procedure, the patient must necessarily come to the doctor and undergo a follow-up examination. When pain occurs, a person should immediately report it to the doctor.

To recover faster, the patient should take all the drugs prescribed by the doctor. Sometimes drug therapy lasts a long time, more than one month in a row.

Be sure to follow a dietary diet after stenting.

It provides for the following:

Complete abstinence from alcohol and smoking.
Ban on all animal fats. Also, you can not eat caviar, chocolate, fatty meat and sweet confectionery.
The basis of the diet should be vegetable soups, fruit mousses, cereals and greens.
You need to eat at least six times a day, but at the same time, portions should not be large.
You should completely limit the consumption of salt and salted fish.
It is important to drink plenty of fluids to maintain normal water balance in the body. It is recommended to drink fruit compotes, juices and green tea. You can also use a rosehip decoction.

In addition, a person needs to control his arterial pressure and blood sugar levels. This is especially important in the presence of already existing hypertension and diabetes, because these diseases can worsen the functioning of the heart.