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SURGICAL TREATMENT OF COMBINED OCCLUSIVE-STENOTIC LESIONS OF EXTRACRANIAL ARTERIES AND AORTO/ILIAC-FEMORAL SEGMENT IN CONDITIONS OF HIGH RISK OF DEVELOPMENT OF REPERFUSION-REOXYGENATIVE COMPLICATIONS.

Today, the issues of surgical tactics remain unresolved, namely, the choice of volume and area of ​​primary reconstruction with occlusion-stenotic lesions of extracranial arteries and aorto-iliac-femoral segment in conditions of high risk of reperfusion-reoxygenative syndrome. The aim of the study - To improve the results of surgical treatment of combined occlusion-stenotic lesions of extracranial arteries and the aorto-iliac-femoral segment in conditions of high risk of development of reperfusion-reoxygenative complications. The study included 58 patients with combined atherosclerotic lesions of extracranial arteries and aorto-iliac-femoral zone. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disorders, ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. The proposed set of measures to prevent the development of reperfusion-reoxygenative complications was introduced to the system of preoperative preparation. The decision of the order of restorative operations on the brachiocephalic arteries and the aorto-iliac-femoral segment was based on the analysis of the localization of the occlusive process in both arterial basins, their hemodynamic characteristics, the degree of ischemia and the tolerance of the brain to ischemia. Due to the spread occlusion-stenotic lesion of extracranial arteries in combination with the stenotic process of the contralateral ICA in the stage of relative compensation of cerebral bloodflow in 7 patients, primarily the surgical intervention on the vessels of the neck was performed. Four to six days after the first surgical intervention, the revascularization of aorta/iliac-femoral segment was performed. In 51 patients, one-time surgical intervention was performed on extracranial arteries and aorto-iliac-femoral basin. Analyzing the results of revascularization operations, it can be argued that a differentiated approach to choosing the tactics of surgical treatment of multifocal atherosclerotic lesions of arterial basins should be used. The revascularization of both arterial basins should be carried out in stages: a reconstructive operation on the extracranial arteries is performed initially, and 4 to 6 days after the first surgical intervention, the aorta/iliac-femoral arterial zone revascularization or revascularization of both arterial basins simultaneously.