Knyazhev, V.

Manolova, M.

Radev, R.

English

Varna Medical University Press: Journals

P L A S T I C O F T H E D E E P F E M O R A L A R T E R Y ON T H E OCCASION O F 47 O B S E R V A T I O N S V. Knyazhev, M. Manolova, R. Radev Key-words: plastic — profound femoral artery — arteriography — Doppler ultrasonogr aphy — prognosis Thrombobliterations affecting femoro-popliteal segment present about 60 — 70 per cent of a l l the cases wi th occlusions in obliterating adenopathies. Femoro-popliteal autovenous shunt is considered an alternative reconstructive operation when this is kind of obliterations is concerned. The usage of the pro-found femoral artery for lower limb revascularization was proposed in 1961 (4). The method of profound plastics is predominantly applied in cases of a dif-fuse lesion of femoral arteries, mul t i l ayer obliterations of femoro-popliteal segment, and atherosclerotic invasion of the profound femoral artery (1—6). Material and methods During the period from 1981 t i l l 1987 about 200 arterial reconstructions were carr ied out in the C l i n i c of Vascular Surgery of the Department of Surgery, Higher Insti tute of Medicine in V a r n a . Of them, in 86 the profound femoral artery was ^vascu la r i zed . We followed-up the results from the application of the isolated profound plastic performed wi th 47 patients. There were 44 males and 3 females wi th an average age of 58.9 years. Only severe extremity ischemia was considered an indication for operation- 27 patients had already reached the I I I r d stage of the disease but 20 ones were even in the I V t h stage wi th distal gangraena. Diabetes occurred as an accompanying disease (among a series of other diseases) in 6 patients. According to plan, a total of 38 patients were ope-rated. Urgently, on the occasion of acute arter ial thromboses and embolisms 9 patients underwent surgical intervention. Arteriography and close Doppler sonography were performed in the course of the c l in ica l examination of the patients. • Results and discussion Three main variations of obliterations affecting both profound and super-f i c i a l femoral arteries were established in our study. Type 1. There was a total thrombosis of a. femoralis superficialis and a stenosis of a. profunda femoris.There were 18 patients in this group. I t occurred almost equally frequently in patients of the I I I r d and of the I V t h stage of the disease. Type 2. Th&re was an intact i n i t i a l segment of the superficial femoral ar-118 V. Knyazhev, M. Manolova, R . Radev tery, 5—6 cm long but there were the same lesions of the profound femoral ar-tery as in type 1. I t occurred more often ( in 45 per cent) wi th patients in the I V t h than wi th patients in the I I I r d stage ( in 37.5 per cent of the cases). Type 3. There was a stenosis of the profound femoral artery and of the in i -t i a l part of the superficial one in 8 patients. I n 6 patients the superficial femoral artery was obliterated in its lower third and in 2 ones it was completely passable but wi th acute proximal thromboembolism. Th i s type was observed in 20.8 per cent of the cases wi th pregangraena and wi th 15 per cent of the cases in the gangraenous stage of the illness. We used autoartery on pedicle flap after disobliteration of the superficial femoral artery for profound plastic in patients of. the first group (6). Mart in ' s method wi th free patch-plastic was applied in patients of the second group. Auto-vena was used in 19 patients and autoartery in 2 ones. Menendeze's method was preferred wi th the patients of the third group. I t consists in simultaneous p la -st ic of both arteries. W i t h a view to the duration of a. profunda femoris stenosis the so-called short profound plastic (up to 2 cm ar ier ia l stenosis) was carried out in 20 patients; standard plastic (stenosis length up to 8 cm) — in 19 patients, and extended plastic (stenosis length over 10 cm) — in 8 patients. Profound plastic was combined wi th endarterectomy from the common and the profound femoral arteries and wi th t ransluminal balloon angioplastic of the proximal arterial stenosis in 48.9 per cent of the cases. The state of t ib ia l arteries was as followed: Both t ib ia l arteries were free of stenosis in 25 per cent of the cases and ste-nosed in 35 per cent of the patients in the I I I r d stage of the disease. Both arteries were obliterated in 40 per cent of the cases. Both arteries were stenosed in 50 per cent, completely obliterated — in 36 per cent of the patients in the I V t h stage of the disease. One artery only was completely obliterated in 14 per cent of these patients. As arteriographic visual izat ion of t ib ia l arteries could not provide sufficiently quali tat ive evaluation possibilities concerning blood flow pathways in some of the patients a Doppler sonography was addit ionally used. I t proved to be particularly significant for the evaluation of the surgical effect, too. Posi t ive changes of regional systolic pressure were noted to a greater ex-tent in patients in the I I I r d than in those in the I V t h stage of the disease. For instance, popliteo- and tibiobracheal indexes increased at the average by 0.22 and 0.12 in the patients in the I I I r d stage but by 0.05 and 0.06, respectively, in those in the I V t h stage of the illness. I n order to read a favourable immediate result the index of total presure in both t ib ia l arteries should be over 0.80 (for patients in the I I I r d stage) and over 0.50(for patients in the I V t h stage) show-ing by a l l means an inc erase of about 0.2 — 0.3 when we analyzed patients wi th improvement and wi th amputation in the two stages of the il lness. Any patients in the two stages of the disease who did not indicate an increase of total t ib ia l pressure index up to 0-40 after profound plastic underwent amputation. During a 5-year period after profound plastic cumulative passabili ty was about 78.5 per cent in patients operated in the I I I stage and 50 per cent in those operated in the I V t h stage of'the disease. Autoarter ial plastic material proved to be more appropriate, especially in patients in the I V t h stage than autovenous one (cumulative 5-year passability was 75 per cent and 29.2 per cent, respecti-v e l y ) . 8 patients had lethal outcome during this period (17.1 per cent) . On the basis of our results the following conclusions can be made: -9$fH Plastic of the. l id h Profound plastic is an effective method for bringing patients' extremity through in the I I I r d stage of the disease. 2. I t should be complemented by other reconstructive operations in pa­tients in the I V t h stage of the illness. 3. To ta l t ib ia l pressure index can significantly prognosticate the outcome of profound plast ic . R E F E R E N C E S .. 1. З а т е в а x и н, И. И., и др. Хирургия (М. ) , 1986, № 12, 4 8 - 5 1 . — 2. Су-х а р е в, И. И., и др. Клин. хирург., 1984, № 7, 46—48. — 4. Т р е г у б е н к о, А. И. , и др. Клин, хирург.. 1987, № 7, с. 60 — 6 . M o r r i s , G . , et a l . Arch. Surg., 82, 1961, 52—57. - 5. Teheri, S., et a l , Vasc. Surg., 16, 1982, N 2, 9 5 - 1 0 5 . - 6. Weibel P. J. Cardiovasc. Surg., 7, 1966, 179-181 . П Л А С Т И К А Г Л У Б О К О Й Б Е Д Р Е Н Н О Й А Р Т Е Р И И ПО ПОВОДУ 47 Н А Б Л Ю Д Е Н И Й , . Княжев, М. Манолова, Р, Радев РЕЗЮМЕ Из произведепних в клиннке около 200 реконструктивния операции на артерия*, V 86 |реваскуляризована глубокая бодренная артерия, лричем у 47 сделана изблирванвая профундопластика. Для последней в двадцпти случаях использована свободная, обично, аутовенозная пластика с заплагкой, у семнадцати аутоартериальная профундопластика и* у 8 пластика глубокой и поверхностноп бедренной артерии пс Menendeze. У 38 больних операция вьшолнена в плановом и у 9 в неотложном порядке. При об~ суждении показаний к операции кроме артериографии, использовани и показатели ултра* ззуково.н доплеросонргр.афии. . " В непосредствен ние и о т д а л е т ш е (около 4 лет) срокп после операции, ампутация б ш г и произведена-11 болъньш (19,1%.). Больпичнля летальность еостлвила 2 ,1% (1 б.ольной). отдаленная — 16,8% (8 больнмх). ' 

PLASTIC OF THE DEEP FEMORAL ARTERY ON THE OCCASION OF 47 OBSERVATIONS

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PLASTIC OF THE DEEP FEMORAL ARTERY ON THE OCCASION OF 47 OBSERVATIONS

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