Experience in outpatient management of patients after hybrid interventions on the arteries of the lower extremities

Introduction. Currently, due to the unsatisfactory results of arterial reconstructions in severe atherosclerotic lesions of the lower leg arteries, the development of postoperative management methods for this patient population is relevant.

Aim. To develop a method for outpatient management of patients after distal hybrid reconstruction using the drug sulodexide.

Materials and methods. The prospective study included 12 people who underwent hybrid surgery for severe atherosclerotic lesions of the femoral and lower leg arteries. All patients underwent the installation of the Cellular Arterial port system (6.5F) intraoperatively after the completion of the main stage. The administration of drugs into and evaluation of the effectiveness of the administration of drugs into the reconstruction area were carried out on an outpatient basis. The first group (n = 6) received sulodexide (Tromboliks® Pro) into the port system, and the second (n = 6) received heparin. The follow-up period for patients was 90 days. The SPSS Statistics 17.0 program was used for statistical data processing.

Results. The results showed that there were no significant differences in the course of the early postoperative period before discharge in the study groups. In the late postoperative period, the average number of recurrences of critical ischemia (group 1 – 2.8 ± 0.8; group 2 – 3.9 ± 0.4, p < 0.05), thrombosis of the tibial arteries (group 1 – 1.8 ± 0.3; group 2 – 2.9 ± 0.2, p < 0.05), repeated operations (group 1 – 2.8 ± 0.2; 2 group – 3.9 ± 0.3 ml, p < 0.05), small amputations (group 1 – 1.9 ± 0.6; group 2 – 2.7 ± 0.7 ml, p < 0.05) of the limb were significantly higher in the control group. In addition, the described complications were observed in the study group from 14 to 21 days, while in the control group – from 30 to 90 days.

Discussion. The antithrombotic effect of heparin on the area of extensive postoperative atheromatosis had a short-term effect. At alater date, a persistent angioprotective effect of thrombolysis was noted, based on an increase in prostaglandin synthesis on 30–90 days after surgery.

Conclusion. The use of the port system with prophylactic courses of heparinization of the vascular reconstruction area with sulodexide in patients after distal hybrid reconstruction with severe atherosclerosis of the lower leg arteries has good clinical results, more pronounced on 30-90 days of the postoperative period.

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