FIELD: medicine; vascular surgery.
SUBSTANCE: when isolating the popliteal artery, the anterior tibial vein is crossed with ligation of its distal part and the proximal segment flowing into the popliteal vein kept patent; the isolated tibioperoneal trunk is opened longitudinally, along its entire length, from the mouth of the anterior tibial artery to the mouth of the posterotibial artery, and the internal walls of the tibioperoneal trunk are inspected, and the orifices of the anterotibial, peroneal and posterotibial arteries, with a mandatory visual assessment of the presence or absence of retrograde blood flow, open thrombectomy or endarterectomy from the tibioperoneal trunk is performed, and the closure of the arteriotomy defect is carried out in the form of applying a patch after thrombectomy or as a distal anastomosis with an autovenous vein prepared for the femoropopliteal shunting and a long arteriotomy hole in the tibioperoneal trunk; in the distal part of the arteriotomy hole — near the mouths of the peroneal and posterior tibial arteries, the mouth of the anterior tibial vein is included in the anastomosis with the formation of an arteriovenous fistula. In addition, in the absence of blood flow from the mouths of the tibial arteries, balloon angioplasty of all three tibial arteries is performed, obtaining satisfactory blood flow through the tibial arteries, both directly during the operation and at a later date, if necessary. The claimed method allows the main blood flow to be carried out directly into the artery of the leg.
EFFECT: restoring blood flow through several arteries in the lower leg allows to maintain adequate blood supply to the lower leg and foot for a long time, as due to the presence of the required number of outflow tracts, increased peripheral resistance does not occur.
2 cl, 2 ex
