The role of intraoperative angiography in the treatment of an acute impassability of the lower extremity artery

Abstract

Objective. To compare the results of surgical treatment of patients, suffering an acute impassability of the lower extremity arteries (LEA) , using and not using intraoperative angiography. Materials and methods. Comparative analysis of the surgical treament results was done in the Centre of Vascular Surgery of Clinical Hospital “Feofania”, where in 2010-2017 yrs 119 patients, suffering an acute impassability of the LEA, were treated. All 119 patients investigated were divided into two groups: the Group I - 70 (58.8%) patients, in whom open thrombectomy, using Fogarty catheter, was performed to correct an acute ischemia of the lower extremity, and the Group II - 49 (41.2%) patients, in whom open thrombectomy, using Fogarty catheter, was followed by the control intraoperative angiography. Taking into account the results of angiography after thrombectomy, the balloon angioplasty was conducted, open surgical interventions on the arteries or thrombectomy only. Results. Performance of intraoperative angiography after thrombectomy gives possibility to determine the origin of an acute impassability of the arteries precisely, to accomplish intraoperative roentgenological control of the thrombectomy conduction and to estimate its quality, to establish a substantiated indications for endovascular and open surgical interventions on the arteries in presence of their stenotic-occlusive affections on background of atherosclerotic process. Expediency of application of intraoperative angiography was witnessed by trustworthily higher rate of thrombectomy performance with positive immediate result in the patients of Group II (97.9%), comparing with the patients of Group I (88.6%) (p < 0.05), as well as the recurrence rate for an acute arterial impassability during a year, which was trustworthily higher in the Group I patients, comparing with the Group II patients – 30.7 and 8.2% (p < 0.001), accordingly. Conclusion. Application of intraoperative angiography and performance of interventions on the arteries in accordance to indications while doing thrombectomy for an acute impassability of the LEA gives possibility to enhance the rate of immediate positive results of the operation and to lower the recurrence rate for an acute arterial impassability during a year trustworthily.

Keywords

• an acute arterial impassability; an acute arterial thrombosis; an acute arterial embolism; an acute ischemia; angiography; thrombectomy; shunting; the balloon angioplasty.