Axiloofemoral Prosthesis in Treatment of Critical Ischemia of the Lower Extremities at Patients with Predicted Short Life Expectancy

The purpose of the study The assessment of the efficiency of the method of axillofemoral prosthesis, which was developed in a clinic, for the treatment of patients with predicted short life time. Materials and methods The analysis of complex examination and treatment of 56 patients with critical ischemia of lower limbs, based on bilateral lesions of aorto-iliac segment of atherosclerotic etiology, was carried out. The patients were divided into 2 groups. The control group included 21 patients, the typical axillofemoral alloprosthesis was made for them. The main group consisted of 35 patients for whom the axillofemoral alloprosthesis of an original way with the imposition of the proximal anastomosis between an axillary artery and an artificial limb "end to end" was made. The diagnostic program included reovasography, Doppler sonography, photoplethysmography, scanning of the upper and lower limbs, heart and a shunt for an indentification of blood flow and magistral blood flow type, the level of microcirculation, occlusive - stenotic lesions of arteries, cardiac hemodynamics, the blood flow with the help of shunt after the surgery. Results and their discussion All Patients had severe concomitant diseases in an decompensation stage with the fraction of left ventricular ejection less than 40%. The use of original treatment technology allows in an immediate postoperative period to increase the volume blood flow through the shunt in 2 times, to reduce the number of postoperative complications in 1.6 times. In the postoperative period the average term of shunt functioning increases in 3 times, the clinical status rises on 19.5%, the physical health component - 12.8%, and the mental component - 9.1% and the lethality is reduced in 2.5 times in comparison with the control group of patients. There was no one patient of the main and control groups with complaints of undue fatiguability of upper limbs, where blood flow was switched to the ischemic lower limb. Conclusion The developed method improves the hemodynamic characteristics of blood flow of the proximal anastomosis and simplifies the imposition of the proximal anastomosis between the axillary artery and the artificial limb.

Obliterating atherosclerosis, Leriche’s syndrome, the critical ischemia, the fraction of left ventricular ejection less than 40%, axillofemoral bypass and prosthesis