PREVENTION OF COMPLICATIONS IN AORTIC-ILIACSEGMENT OCCLUSION SURGERY

Abstract

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.