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3 . 2022

Identification of the causes of autovenous femoro-popliteal bypass occlusion in the long-term postoperative period

Abstract

The study performed a search for risk factors for occlusion of autovenous femoral-popliteal bypass in the long-term period after surgical treatment.

Aim: to assess influence of metabolic status, severity of comorbid pathology and features of lesions of the arterial bed of the lower extremities on the development of occlusion of autovenous femoral-popliteal bypass in the long-term postoperative period.

Material and methods. The data of 358 patients who underwent autovenous femoral-popliteal bypass were prospectively analyzed. The patients were divided into 2 groups depending on the patency of the bypass: 116 patients diagnosed with femoral-popliteal bypass occlusion made up the 1st group; patients with a passable femoral-popliteal bypass were included in the 2nd group. An analysis of metabolic disorders, concomitant pathology and features of arterial lesions was performed.

Results. The relationship between changes in the leukogram, lipidogram and occlusion of the autovenous femoral-popliteal bypass was revealed. An increase in glucose, C-reactive protein and creatinine levels may affect the timing of autovenous femoral-popliteal bypass. The presence of arterial hypertension, heart failure, diabetes mellitus, especially in its decompensated course, reduces the service life of autovenous femoral-popliteal bypass. Severe atherosclerotic changes in the arteries of the lower extremities with impaired inflow pathways contribute to the occlusion of autovenous femoral-popliteal bypass. Poor compliance results in a shorter lifespan of autovenous femoral-popliteal bypass.

Conclusions. Chronic anemia, a long-term inflammatory process, increased levels of creatinine, glucose, and higher lipidogram values contribute to the occlusion of an autovenous femoral-popliteal bypass, these changes are most important when forming a distal anastomosis below the knee joint gap. The multifocal course of the atherosclerotic process, the presence of arterial hypertension, diabetes mellitus and chronic kidney disease significantly reduces the service life of autovenous femoral-popliteal bypass, especially in patients with stage 4 ischemia of the lower extremities according to the Fontein–Pokrovsky classification; damage to the popliteal artery and arteries of the lower leg, a multilevel lesion involving the iliac arteries and arteries of the lower leg reduces the service life of the autovenous femoral-popliteal bypass; adherence of patients to the prescribed therapy significantly increases the service life of autovenous bypass, especially at the level of formation of the distal anastomosis below the knee joint gap.

Keywords:autovenous femoral-popliteal bypass grafting; occlusion; risk factors; metabolic disorders; comorbid pathology

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Artemova A.S., Komakha B.B., Chernyavskiy M.A. Identification of the causes of autovenous femoro-popliteal bypass occlusion in the long period after surgical treatment. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 13–22. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-13-22  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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