Predictors of complications of open surgery of the aorto-iliac segment occlusion

Background. Treatment of occlusive lesions of the aorta-iliac segment (AIS) is difficult because of the presence of concomitant multifocal lesions of the arteries of the vital organs – the heart, brain, kidneys, visceral organs.

Aim. Scientific rationale for a set of measures to improve the results of open surgical treatment of patients with occlusive disease of AIS.

Material and methods. A prospective non-randomized clinical study of the surgical treatment of 134 patients with AIS occlusive disease was performed, who, depending on the treatment tactics, were divided into 2 groups: without correction and with correction of predictors of complications. The 1st group consisted of 70 patients with an unstable course of AIS occlusion, the 2nd group included 64 patients who, if indicated, underwent preliminary surgical correction of coronary and carotid artery pathology, pelvic revascularization, and preliminary correction of renal failure. Results. Complications in the 30-day postoperative period in patients of the 1st group resulted in 4 (5.7%) deaths, 1 (1.6%) death was registered in the 2nd group of patients. 5-year mortality in patients of the 1st group was 5 (7.7%) cases, in the 2nd group – 2 (3.3%) cases.

Conclusion. Analysis of the end points of the study showed that the 30-day mortality was affected by the correction of predictors of complications and the development of multiple organ failure; 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 – on the blood creatinine level; in the 5-year postoperative period, the development of myocardial infarction depended on the correction of predictors of complications, acute renal failure – on the blood creatinine level, and chronic ischemia of the left colon half – on 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.

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