[Treatment of thrombotic complications of surgical infrainguinal revascularizations]

Authors in the work analyse the patients hospitalized with thrombosis of the surgical infrainguinal reconstruction. They evaluate the causes of reconstructions occlusions, therapeutic options in the treatment and their experiences with treatment of these patients.

It is the retrospective analysis of the patients hospitalized during years 2001-2006 at the Department of Vascular Surgery of the Teaching Hospital J. A. Reimana in Presov with thrombosis of the surgical infrainguinal reconstruction. During the study period 723 surgical infrainguinal revascularization procedures were performed. The basic therapeutic approach in the care of these patients is anticoagulation and digital subtraction angiography, then they decide between percutaneous endovascular treatment, surgical thrombectomy, reoperation with implantation of the new reconstruction or conservative treatment. In the phase of irreversible ischemia high amputation is indicated.

Thrombosis of the reconstruction was occured in 109 subjects (15.8%). Prothesis was thrombosed in 71 subjects (65.14%), vein in 38 subjects (34.86%). Percutaneous endovascular treatment was indicated in 3 subjects (2.8%), surgical thrombectomy with correction of the stenosis in 23 subjects (21.1%), reoperation with implantation of the new reconstruction in 53 subjects (48.6%),conservative approach in 21 subjects (19.3%), high amputation in 9 subjects (8.2%). The secondary patency after 12 months according to the life table method analysis after percutaneous endovascular treatment was 75%, after surgical thrombectomy of the graft with correction of stenosis 37% and after reoperation with implantation of the new reconstruction 72%.

Authors believe that the best treatment in the care of the patients with thrombosis of the surgical infrainguinal reconstruction and critical limb ischemia is implantation of the new secondary reconstruction with autologous vein.