Abstract:

Background: article presents a case of 11-month-old baby weighing 6,590, with phenomena of circulatory decompensation, and non-standard hybrid intervention using retroperitoneal open access to the infrarenal aorta - stent implantation with the potential for increasing its diameter as the child grows

Materials and methods: the patient underwent examination - echocardiography (Echo-CG), multispiral computed tomography (MSCT), angiography Indication for the operation was the restenosis of the distal aortic anastomosis after the stage-by-stage surgical correction of hypoplastic left heart syndrome (Norwood procedure). This tactic was chosen taking into account the extremely high risk of re-surgery, as well as the impossibility of stent implantation with the potential for increasing the diameter through access to the femoral artery (body weight of the child is 6.6 kg). The patient underwent stenting of restenosis of the distal aortic anastomosis through retroperitoneal open access to the infrarenal aorta.

Results: good early postoperative period, against the background of disaggregant therapy (aspirin 5 mg/kg per day) and antibiotic therapy In control echocardiography (Echo-CG), the systolic pressure gradient in the stent implantation zone is 22 mm hg. The patient was discharged to an outpatient stage, followed by examination after 6 months and possible re-intervention (stent dilatation with a larger diameter balloon) as the pressure gradient rises as the child grows. Proposed hybrid approach in a child 11 months with a body weight of 6,590 kg allowed to avoid the risk of re-surgery in conditions of circulatory arrest and demonstrated a satisfactory angiographic and clinical result.

Conclusion: stenting of restenosis in distal aortic anastomosis using retroperitoneal access can be considered as a surgery of choice in specialized centers.

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Abstract:

This article presents a review of the literature on treatment of multifocal atherosclerosis of iliac arteries and arteries of lower extremities. Adequate correction of arterial inflow provides normal functioning of distal reconstructions. Combination of endovascular correction of arterial inflow with open surgical reconstructions of arterial outflow maximizes limb revascularization and this leads to less surgical trauma and less complications. Hybrid operations allow to achieve maximum results in terms of hemodynamics in patients with multi-segmental lesions. Immediate and long-term results of such operations are not worse than similarly isolated interventions in each segments. Hybrid operations show their worth and effectiveness in all lesions of aorto-iliac segment, including TASC C and D. Reduced operational trauma during hybrid operations, compared with one-stage surgical reconstruction, and the possibility to perform interventions under regional anesthesia, are particularly important in patients at high risk of comorbidity

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Abstract:

Purpose: Was to observe the immediate and long-term results of hybrid operations in multilevel atherosclerotic lesions of aorto-iliac(AIS) and femoral-popliteal segments (FPS). Article describes the method of the hybrid intervention in the aorto-iliac segment

Materials and Methods: For the period of 2007-2011 - 40 patients with multilevel lesions of iliac arteries and lower limb arteries underwent hybrid operations. 57.5% of patients had aorto-iliac segment disease, classified as TASC C, and 42,5% - TASC D. Lesions of femoral-popliteal segment was divided in the following order: TASC A - 15,0%, TASC B - 35,0%, TASC C - 42,5% and TASC D - 7,5%. We applied loop endarterectomy with stenting for the correction of the aorto-iliac lesions. For arterial outflow correction we applied surgical operations. Follow-up period has been traced for 3 years.

Results: Primary technical success was achieved in 97.5%. Complications of the immediate postoperative period were noted in 15%. Long-term results were traced for 3 years in 70% of patients. Three-year assisted patency of aorto-iliac segment was 89%. All complications have been corrected only by endovascular procedure. Three-year cumulative patency of femoral-popliteal segment was 87%.

Conclusions: This technique allows achieving the best results in reducing lower limb ischemia. Simultaneous correction of both - inflow and outflow segments improved long-term results of each of the reconstruction. The method shows its effectiveness in patients with TASC C and TASC D lesions of aorto-iliac segment. Reduction of surgical trauma significantly affects the results in group of high risk patients. 

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