METHOD OF SURGICAL TREATMENT OF CHRONIC ISCHEMIA cults THIGH stage III-IV

摘要

FIELD: medicine.;SUBSTANCE: invention relates to field of medicine, in particular to vascular surgery. UIA is cut on lower-lateral surface from lower bifurcation angle 2.5-3.0 cm downward with formation of arteriotomic hole. CIA arteriotomy is performed on length of occluded section extension. LIA is cut from lower CIA bifurcation angle in distal direction on LIA anterior surface at angle to longitudinal LIA axis with length 2.5-3.0 cm. After that, cut is continued in reverse direction on posterior LIA surface parallel to line of cut on anterior LIA surface to the beginning of the cut. Cut-off part of LIA is removed, cutting it transversally 0.5-1.0 cm higher than orifice of the first of large LIA branches in area of inguinal ligament. From cut-off part of LIA cur out is one pentagonal fragment of patch, cutting its longitudinally along short generastrix or two rectangular fragments of patch, cutting it transversally along short generatrix and long generatrix. In case of necessity, open endarterectomy from LIA and CIA is performed. UIA plasty is performed with autoarterial flap, sewing posterior edge of UIA cut and posterior edge of patch from LIA leaving 0.5-1.0 cm to lower angle of artery bifurcation. Autoarterial patch from pentagonal fragment is applied with acute angle down on UIA, placing its rectangular part on CIA and sew it into CIA cut leaving 0.5-1.0 cm to lower edge of artery bifurcation. After that suture on anterior UIA surface, end of CIA arteriotomy cut and patch are connected. Suture is continued on anterior UIA surface, anterior edge of UIA cut is sewn with patch edge and suture is finished by sewing anterior side of cut, which cuts off LIA with patch edge. In case if CIA arteriotomy has greater length autoarterial patch is composed of two rectangular fragments, connecting them, patch is applied with acute angle down on UIA, placing the remaining part on CIA. UIA pasty is performed with autoarterial flap, beginning with sewing patch into CIA cut leaving 0.5-1.0 cm to lower angle of artery bifurcation, suture is made on anterior UIA surface, edges of CIA arteriotomy and patch are connected. Suture is continued on anterior UIA surface, and finished by sewing together anterior side of cut, which cuts off LIA with patch edge.;EFFECT: method makes it possible to increase efficiency of surgical treatment of hip stump ischemia, which is achieved due to formation of flap of large size.;7 dwg, 2 ex