RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CRITICAL ISCHAEMIA OF THE LOWER EXTREMITIES USING BIFURCATION SELECTIVE PROFUNDOPLASTY WITH REVERSED AUTOVENOUS GRAFTING

Abstract

This article discusses the problems of surgical tactics in critical ischaemia of the lower extremities and its complications, both in the early postoperative period and in the long term. High limb amputation rates are prompting surgeons to search for the optimal surgical treatment method to achieve the best results. Amputation below the knee joint is considered preferable, as preserving the knee joint significantly improves functional outcomes, in particular the possibility of successful prosthetics and restoration of limb support. However, stump survival, the risk of postoperative complications, and the potential for prosthetics depend to a large extent on adequate blood supply in the amputation area. Aim: To improve the results of surgical treatment of patients with critical lower limb ischaemia using bifurcation selective profundoplasty with reversed autovenous grafting. Materials and Methods: This study involved 63 patients who underwent surgery between 2022 and 2024 in the city of Semey, Abai region. The study examined the general characteristics of surgical interventions performed on patients with critical lower limb ischaemia using the treatment methods we proposed to improve the final results. Results: The analysis showed that patients who underwent lower leg amputation combined with bifurcation profundoplasty had better postoperative outcomes compared to the group that underwent isolated amputation. In the second group, complications from the stump were significantly less common, the ability to undergo prosthetic replacement was higher (71.9% vs. 45.2%, p < 0.05), and patency of the deep femoral artery was maintained in 81.3% of cases during 12 months of follow-up. Conclusions: The data obtained confirm that preservation of the knee joint during amputation, combined with optimisation of collateral blood flow through profundoplasty, contributes to better functional outcomes and improved quality of life for patients. The proposed combined approach can be considered an effective alternative to isolated amputation in patients with severe vascular pathology and limited possibilities for direct revascularisation.