G. KordzakhiaRepublican Scientific and Practical Center "Cardiology, Belarus
Title: Long-term results of surgical treatment of patients with combined lesions of brachiocephalic arteries and arteries of the lower extremities
Introduction: In Belarus, cerebral infarction is the second most important cause of death and disability among cardiovascular diseases. In 2019, more than 33,000 people in our country had a cerebral infarction, and 14.5% of these patients passed away. The number of lower extremity amputations in Belarus is about 13.4 cases per 100,000 population per year. The number of lower limb amputations in patients of working age is increasing, which is associated with huge material expenses on their medical and social rehabilitation. It is necessary to decide what treatment tactics to choose for these patients - one-stage or staged vascular reconstruction. What should be reconstructed first: brachiocephalic arteries or lower limb arteries? There is no definitive answer to this question.
Purpose of the study: To develop and implement a strategy for surgical treatment of patients with combined atherosclerotic lesions of the carotid arteries and arteries of the lower extremities.
Methods and materials: A retrospective prospective study. In 2014-2022 220 patients with combined atherosclerotic lesions of the carotid arteries and lower limb arteries were treated at the vascular surgery department of N.E. Savchenko 4th City Clinical Hospital and the 1st cardio surgery department of the Republican Scientific and Practical Center "Cardiology". The patients underwent one-stage and staged surgeries (carotid endarterectomy and reconstruction of lower limb arteries). Their age varied from 60 to 85 years, including 39 women and 181 men. The following long-term outcomes were studied: overall mortality, cerebral infarction, primary amputation.
Results and discussion: The actuarial survival calculated using Kaplan-Meier curves was 93% after 2 years, 90% after 3 years, and 85% after 4 years (Figure 1). In the long-term postoperative period, one-stage operations did not result in an increase in the number of amputations, brain infarcts, and mortality compared with staged interventions (Fig. 1, 2, 3).
Conclusions: Complex one-stage surgeries are justified and require compliance with the algorithm of preoperative examinations and careful selection of patients.
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