Authors
Sleptsov P.A.1, Shlomin V.V.1, 2, Bondarenko P.B.1, 2, Gusinskiy A.V.1, 2, Kucherenko V.S.1, Fionik O.V.1
1 Almazov National Medical Research Center, St. Petersburg
2 Municipal Multi-Specialty Hospital № 2, St. Petersburg
Abstract
Purpose of the study. To evaluate the impact of simultaneous lower extremity artery reconstruction on the early and long-term outcomes in patients after open surgical treatment of infrarenal abdominal aortic aneurysms.
Materials and methods. The study included 163 patients with infrarenal AAA and hemodynamically significant lesions of the ilio-femoral and femoro-popliteal segments (TASC II types C and D) who underwent elective open surgical treatment between 1997 and 2022. The patients were divided into two groups: Group 1 (n = 66) – simultaneous open surgery: open surgical treatment of infrarenal abdominal aortic aneurysm with reconstruction of the lower extremity arteries (n = 66); Group 2 (n = 97) – isolated open surgical treatment of infrarenal abdominal aortic aneurysm (n = 97). The mean retrospective follow-up period was 7 years (range 5 to 15 years).
Results. Group 1 showed a significant increase in operative time (251±54 min vs. 197±35 min in Group 2; p = 0.001), aortic and arterial cross-clamp time (p<0.001), and a higher incidence of acute renal failure (10% vs. 3%; p = 0.05). In-hospital mortality did not differ significantly between the groups (9% vs. 3%; p = 0.1). In the long-term period (up to 15 years), Group 1 demonstrated significantly higher rates of primary patency (p = 0.001) and freedom from re-interventions (p = 0.001) compared to Group 2. The cumulative limb salvage rate and overall survival did not differ between the groups (p = 0.9).
Conclusion. Simultaneous reconstruction of the lower extremity arteries during open surgical treatment of infrarenal abdominal aortic aneurysms in carefully selected patients increases operative time and the rate of early postoperative complications but does not lead to a significant increase in in-hospital mortality. In the long term, this strategy provides significantly better primary patency and reduces the frequency of repeat interventions by ensuring adequate distal runoff.
Keywords: аbdominal aortic aneurysm, open surgical repair, peripheral arterial disease, simultaneous lower extremity revascularization, long-term outcomes.
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