PREVENTION OF COMPLICATIONS IN AORTIC-ILIAC SEGMENT OCCLUSION SURGERY
Relevance. Very often, occlusion of the aorto-iliac segment (AIS) is combined with atherosclerotic lesions of the arteries of vital organs that influence the development of complications and mortality. The choice of treatment tactics remains the most difficult task.
Purpose of the study. Scientific rationale for a set of measures to improve the results of open surgical treatment of patients with occlusive disease of AIS.
Materials and methods. . A prospective non-randomized clinical study of the results of surgical treatment of 134 patients with occlusive AIS lesion was performed. All patients were divided into 2 groups: the 1st group - 70 patients with unstable course of AIS occlusion, the 2nd group - 64 patients who according to the indications were preliminarily corrected for significant concomitant pathology of the vital organs. For the analysis of quantitative data Student t-test, one-way analysis of variance, Mann-Whitney, Kraskell-Wallis test were used. To compare qualitative characteristics χ2 Pearson, Fisher's exact test were used. Complications and mortality predictors were analyzed using logistic regression and Cox regression.
Results. Fatal outcome in the 30-day postoperative period in patients of the 1st group - in 4 (5.7%) cases, in the 2nd group of patients - in 1 (1.6%) case. 30-day mortality in the 1st group of patients was 27,0 days (95% CI 25,233-28,767), in the 2nd group of patients – 28,859 days (95% CI 28,081-29,637), (Log Rank = 7,823; p = 0,043). 5-year mortality in patients of the 1st group was 5 (7,7%) cases, in the 2nd group - 2 (3,3%) cases. Survival of patients in the 5-year period in the 1st group of patients was 56,1 (95% CI 52,7-59,5) months, in the 2nd group of patients 58,4 (95% CI 56,3-60,0) months (Log Rank = 0,834; p = 0,361).
Conclusion. Correction of predictors of complications in the early and late postoperative period reduces the 30-day mortality. In the 30-day postoperative period, the development of myocardial infarction depended on the correction of predictors of complications and ejection fraction, acute renal failure - from the level of creatinine in the blood; in the 5-year postoperative period, the development of myocardial infarction depended on the correction of predictors of complications, acute renal failure from the level of blood creatinine, and chronic ischemia of the left colon half - from stenosis of the internal iliac artery (IIA), antegrade or retrograde inclusion of the IIA in the main blood flow during reconstruction of the AIS; 5-year survival of patients was affected by the correction of predictors of complications and the development of such complications as myocardial infarction and acute renal failure.
Altay A. Dyussupov 1, http://orcid.org/0000-0003-0875-1020
Bekzhan S. Bulanov 1, http://orcid.org/0000-0001-8091-9663
Almas A. Dyussupov 1, https://orcid.org/0000-0002-2086-8873
Dauren B. Auzhanov 1, https://orcid.org/0000-0001-8378-0054
Azhar A. Dyussupova 1, http://orcid.org/0000-0002-8857-4118
Baktybala B. Dyussupova 1, https://orcid.org/0000-0002-2658-4839
1 «Semey Medical University» NJSC, Semey city, Republic of Kazakhstan
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Dyussupov A.A., Bulanov B.S., Dyussupov A.A., Auzhanov D.B., Dyussupova A.A., Dyussupova B.B. Prevention of complications in aortic-iliac segment occlusion surgery. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 4, pp. 72-79.Related publications:
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