Abstract:

Aim: was to show the role and possibilities of 128-slice computed tomography (MSCT) iirfhe dynamic observation of patients; after open and endovascular surgery of lower limb's arteries;

Material and methods: 1st group - 36 patients (30,5%) who (underwent endovascular procedures;, 2nd group - 51 patients; (44,2%) who underwent open reconstructive operations;, 3rd group - 31 patients; (26,3%) after hybrid operations;. 108 patients; were examined in post-operative period (7 women, 101 men), average age was 57,28±15,08. All patients underwent MSCT-angiography on the background of the contrast bolus;. 55 patients; had standard procedure, other patients; underwent examination with low-close protocol.

Results: obtained images of low-close protocol had satisfactory condition of information: arterial walls were visualized well, inner lumen and para-prosthesis space, atherosclerotic lesions were also visualized. Obtained results of MSCT-angiography during low-dose protocol were confirmed ntraoperatively Obtained data of MSCT-angiography: all patients; of 1st group had passable stents; but 2 patients; who had hernodynarnically non-significant stenosis. In 2nd group 5 patents; had restenosis of prosthesis and grafts;, 20 patients; had thrombosis. In 3rd group, 2 patients; had restenosis of prosthesism femoral-popliteal segment, 13 patient had thrombosis of prosthesis/grafts, 6 patients; had restenosis of stents;, 1 patient had stent thrombosis in femoral-popliteal segment, n case of hernodynarnically significant stenosis (50%) of the stent or prosthesis in the absence of clinical manifestations; we made correction of drug therapy. If the patent had a detected boundary stenosis (50-74%) with the absence of complaints;, the patient had correction of drug therapy, with the appointment of a dynamic MSCT-angiography in 3-6 months. Patents; with occlusion of the prosthesis, or a stent with a satisfactory distal vessels clue to good collaterals; we performed thrombectomy or repeated prosthetics. Patients who according to the MDCT-angiography, had identified thrombosis of prosthesis/grafts with poor distal vessels, absence of good collaterals; and the presence of clinical manifestations; of critical ischemia - amputation of the affected limb.

Conclusion: MSCT-angiography is a highly informative method of nornnvasive imaging of patency of stent, prosthesis/graft of mam arteries; of lower limbs;. Our study showed that using of a low-close protocol is; possible for the dynamic monitoring of patents; for the detection of postoperative complications;, early diagnosis and prevention of restenosis and thrombosis of prosthesis/grafts and stents Timely diagnosis of stenosis of stents; or grafts/prostheses of mam arteries; of lower limbs can determine tactics; and stages; of surgery (endovascular treatment, and re-open reconstructive vascular surgery, thrombectomy), not leading to the patient’s; disability. 

References

1.     Bokerija, L. A., Gudkova R.G. Serdechno-sosudistaja hirurgija - 2010. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija: Prakticheskoe rukovodstvo[Pathology and congenital anomalies of circulatory system. Practical guide-book]. M.: NCSSH im. A. N. Bakuleva RAMN. 2011; 191 c [In Russ].

2.     Pokrovskij A.V., Doguzhieva R.M., BogatovJu.P., i dr. Otdalennye rezul'taty aorto-bedrennyh rekonstrukcij u bol'nyh saharnym diabetom 2 tipa[Late outcomes of aorto-femoral reconstructions in patients with diabetes mellitus type 2]. Angiologija i sosudistajahirurgija. 2010; 16 (1): 48-52[In Russ].

3.     Poljancev A.A., Mozgovoi P.V., Frolov D.V., i dr. Trombofilicheskie sostojanija v patogeneze pozdnih tromboticheskih reokkljuzij u bol'nyh obliterirujushhim aterosklerozom arterii nizhnih konechnostej [Thrombofillic conditions in pathogenesis of late thrombotic occlusions in patients with atherosclerosis of lower limbs]. Vestnik jeksperimental'noj i klinicheskoj hirurgii. 2011; 2 (4): 208-211[ In Russ].

4.     Kokov L.S. Luchevaja diagnostika bolezni serdca i sosudov: nacional'noe rukovodstvo. [Radiodiagnostics of heart and vessels pathology. National guide-book] M.: GJeOTAR- Media. 2011; 688 [In Russ].

5.     Bokerija, L.A., AlekjanB.G. Rukovodstvo rentgenjendovaskuljarnoj hirurgii serdca i sosudov 3t [Guide-book of endovascular surgery of heart and vessels. Volume 3]. M: NCSSH im. A.N. Bakuleva RAMN. M. 2013; 598 [In Russ].

6.     Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterij nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. MedicinskijvestnikMVD. 2014; 6 (73): 47-49[In Russ].

7.     Kayhan A., Palab y k F., Serinsoz S. et а!. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetectorCT a valuable screening tool? Eur. J. Radiol. 2012; 81(3): 542-546.

8.     Mamet'eva I.A., Miheev N.N. Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. Medicinskij vestnik MVD. M. 2015; 78 (5): 42-47[ In Russ].

9.     lezzi R., Santoro M., Dattesi R., et al. Diagnostic accuracy of CT angiography in the evaluation of stenosis in lower limbs: comparison between visual score and quantitative analysis using a semiautomated 3D software. J. Comput. Assist. Tomogr. 2013; 37 (3): 419-425.

10.   Pomposelli F. Arterial imaging in patients with lower-extremity ischemia and diabetes mellitus. J. Am. Podiatr. Med. Assoc. 2010; 100 (5): 412-23.

11.   Mamet'eva I.A., Miheev N.N., Obel'chak I.S. i dr. Primenenie nizkodozovogo protokola u pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej. Nash opyt[Low-dose protocol in patients after reconstructive procedures on main arteries of lower limbs]. REJR. Materialy IX Vserossijskogo kongressa luchevyh diagnostov i terapevtov «Radiologija 2015».M. 2015; 5 (2): 69 [ In Russ]

12.   Mahnken A.H., Bruners P., Mommertz G. Et al. Carbon dioxide contrast agent for CT arteriography: results in a porcine model. J. Vasc.Interv. Radiol. 2008; 19 (7):1055-1064.

13.   Mizuno A., Nishi Y, Niwa K. Total bowel ischemia after carbon dioxide angiography in a patient with inferior mesenteric artery occlusion. Cardiovasc. Interv. Ther. 2014; 6(3): 642-650.