Clinical Study of the Aorta-femoral Bypass and Hybrid Intervention and the Iliac Arteries With Stenting and Plasty of the Common Femoral Artery Effectiveness in Patients With the Iliac Segment and Femoral Artery Occlusive Disease (TASC C, D)
Condition: Atherosclerosis of the Peripheral Arteries
MeSH terms: Atherosclerosis
Study type: Interventional

Summary: 
      Currently, according to the TASC II consensus document (2007) and the Russian guidelines for
      limb ischemia treatment (2010), aorta-iliac C and D type segment lesions the open surgery is
      suggested.
    

Detailed description: 
      Currently, according to the TASC II consensus document (2007) and the Russian guidelines for
      limb ischemia treatment (2010), aorta-iliac C and D type segment lesions the open surgery is
      suggested.

      According to different studies, 76% occlusive aorta-iliac article course patients indicate
      femoral-popliteal segment lesions. Due to the lack of inflow and outflow ways of correction
      needed for adequate limb revascularization surgery treatment of multistorey atherosclerotic
      lesions patients is still one of the most complex problems of vascular surgery.
      Perioperational mortality of critical limb ischemia patients reaches 5-10% in retrograde
      aorta-iliac segment reconstruction.

      Due to its high efficiency hybrid operative invasion is one of the most perspective
      directions in reconstructive vascular surgery development (92-98% of the cases with the small
      number of post-operative complications).

      Furthermore, hybrid surgery is possible with the critical iliac segment and femoral artery
      lesions, since stenting in the field of physiological bends (femoral artery) may lead to its
      breaking and artery thrombosis. Arterial segments blood flow reconstruction is possible with
      hybrid innervations meaning iliac segment stenting and common femoral artery patch.

      All reports of iliac arteries stenosis percutaneous angioplasty indicate that the primary
      technical and clinical success rate exceeds 90%. The technical success of iliac arteries long
      occlusions recanalization reaches 80-85%. Improvement of endovascular equipment designed for
      the total occlusions treatment increases technical success of recanalization. The TASC II
      materials summarize the several large studies results which present the data on the operated
      segment artery patency at the level of 70-81% within 5-8 years of follow up. A large number
      of authors note the actuality of aortic-iliac type C and D segment lesions endovascular
      treatment recommendations revision according to the TASC II, together with hybrid technics
      implementation in this category of patients.
    

Intervention name(s): Hybrid Intervention; Aorta femoral Bypass
Intervention type(s): Procedure; Procedure
Intervention description(s): The puncture of the femoral artery general is executed and the introducer 7Fr is set. Further, the hydrophilic conductor executes a recanalization of the Vasa of iliac artery occlusion. if you cannot pass the occlusion retrograde is additional access to antegrade recanalization. Then using hydrophilic conductors, an iliac artery antegrade or retrograde recanalization of the Vasa is made.
Femoral artery arteriotomy. Further execute a direct endarterectomy femoral artery and from the mouth of a hip artery.
arteriotomy of the femoral artery is closed with a vascular patch use (synthetic or biological).
Balloon angioplasty and stenting, iliac artery is done, the controlling angiography Closing maims.; It is sufficient to identify only the anterior-lateral aorta surface. After heparinization the aorta is clamped above and below the anastomosis. The aorta is dissected along the anterior wall, calcium portions or mural thrombus are removed. Prosthesis is cut obliquely and anastomosis suturing starts with distal angle. Occluded at the prosthetic base jaws, aortic compressor is removed, restoring blood flow in the lower limb. Next stage is tunnel creating for jaws prosthesis conduction on hip. Ureters must remain over the prosthesis, jaw should be above the iliac arteries. After jaws prosthesis conduction on hip distal anastomosis is formed with twisting controlling. Before anastomosis completion the testing jaws and all arteries bloodletting is performed.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: atherosclerosis of the peripheral arteries; Aorta-femoral Bypass; Hybrid Intervention; Iliac Arteries With Stenting and Plasty of the Common Femoral Artery; plastic arteries with lesions of the common femoral artery and deep femoral artery