IMPROVEMENT OF THE TECHNIQUE OF BYPASS INTERVENTIONS ON THE FEMOROPOPLITEAL SEGMENT IN PATIENTS WITH CHRONIC ARTERIAL INSUFFICIENCY OF THE LOWER LIMB

Background: Despite the increasing number of X-ray endovascular operations on infrainguinal lesions of lower limb arteries open surgery remains highly relevant. The operating time of open surgeries cannot be considered satisfactory, especially when combined shunts are used in the infrainguinal position. Research objective is to improve the results of shunt operations at atherosclerotic lesions of the femoropopliteal segment by advancing the technique of determining the required extent and applying the autotransplant material. Material and methods. 72 patients were involved in the research. All the patients underwent the femoropopliteal shunt procedure. The instruments designed by us (autovenous shunt length meter and the device for tunnel formation and for applying the shunt into the tissues) were used in the first group. Patients from the second group were operated on with the use of the classical technique and equipment. Results. No combined shunts were used in the first group of patients in comparison with the second group (n=5). Statistically significant results (p<0.05) between the studied groups were obtained according to such criteria as number of cases of intraoperative shunt torsion (p=0.0171), length of unused autograft material (p=0.0001), ankle brachial index increase (p=0.024), the number of early postoperative complications (p=0.028), the number of shunt dysfunctions (p=0.0203) and shunt functioning duration (p=0.013). Conclusions. The use of the patented instruments when performing femoropopliteal shunting allows to determine precisely the required amount of autotransplanted material and to provide its more convenient applying in the subcutaneous tunnel. The use of the patented instruments when performing femoropopliteal shunting with a reversed autovein made it possible to improve the technique of this revascularization operation: to accurately determine the required amount of autograft material which excluded the presence of patients with combined shunt in the first group, as well as to perform the simultaneous creation of a tunnel in the soft tissues of the thigh, shin and reliable shunt placement, excluding it's rotation along the axis. The use of the patented instruments when performing femoropopliteal shunting allowed to get positive results in the first group, in comparison with second group of patients both in the early and late postoperative periods.