Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case
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1 Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case Chernyavskiy M.,MD,PhD, Chernova D., Zherdev N., Chernov A. Almazov National Medical Research Centre, St.Petersburg, Russia 2019
2 Disclosure Speaker name:...chernova DV... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 The challenges of multilevel lower extremities lesions: ~ 20% patients with PAD Usually elderly patients (older 70 years): Increased risk of open reconstructions because of comorbidities, Increased risk of combined arterial lesions, Increased risk of multilevel lesions in one arterial area.. Mini invasive strategy of hybrid surgery..
4 Hybrid techniques in management of peripheral vascular disease rational combined treatment of patients suffering from PAD with endovascular and open ( classic ) surgery, performed simultaneously and in a single operating room.
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6 A 72-year-old man Clinical case Progressively worsening claudication of both lower extremities, Walking capacity less 100 m, ABI right 0,49 / left 0,54 Risk factors: Smoking Arterial hypertension Hyperlipidemia Diabetes mellitus
7 Co-morbidity: Atherosclerosis of the brachiocephalic arteries (occlusion of the left internal carotid artery, stroke in 2017), CAD (MI in 1997), PTCA of the right coronary artery in According to the angiography of the lower extremity arteries: occlusion of the left common iliac artery (CIA); occlusion of the right external iliac artery (EIA); occlusion of the right common femoral artery (CFA) and superficial femoral artery (SFA), ostial stenosis profund femoral artery (PFA) to the right.
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10 Surgical strategy: Using local anesthesia (Lidocaini 0.1%); Endarterectomy from right CFA, ostium PFA, xenopericardial patch plasty; Angiographic control via the right brachial artery (PigTail); Retrograde subintimal recanalization of CIA on the left by glidewire stiff (0,035 ); Retrograde recanalization of EIA on the right by glidewire stiff (0,035 ); Balloon angioplasty with stenting of EIA on the right, followed by balloon angioplasty with CIA stenting on the left (predilatation ballon d=5mm, selfexpanding nitinol stents, optimal postdilatation)
11 Result: The early postoperative period without features, Ankle-brachial index increased - right 0.71/ left 0.89; The patient was discharged on the 3rd day after surgery; In duplex-control after 1 and 3 months stents with good inflow.
12 Conclusion Hybrid procedures on the aorto-femoral segment can avoid extensive surgical trauma, postoperative complications and reduction in-hospital stay; Endarterectomy in CFA improves blood flow and recommended for patients with it occlusions/ hemodynamic stenosis; Hybrid treatment of such lesions is a safe, feasible and minimally invasive method with lower mortality than open surgery, especially in high risk patients. P.S. In case of the return clinic of progressive ischemia of the right lower limb to this patient, revascularization of the femoral-popliteal segment is possible.
13 Thank You!
14 Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case Chernyavskiy M.,MD,PhD, Chernova D., Zherdev N., Chernov A. Almazov National Medical Research Centre, St.Petersburg, Russia 2019
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