CONSTITUTIONAL PREDICTORS OF THE DEVELOPMENT OF LIFE-THREATENING COMPLICATIONS DURING SURGICAL TREATMENT OF AORTO-FEMORAL “C-D” TASC II LESIONS, USING LAPAROTOMIC AND RETROPERITONEAL ACCESSES
Authors: S.E. Suzdaltsev , R.A. Sulimanov , R.R. Sulimanov , E.S. Spassky , M.D. Grigoryan 
Published: February 2024

Relevance. Currently, the use of transperitoneal and retroperitoneal approaches in surgery for lesions of the aorta and iliac arteries remains necessary. In our previous studies, we expressed an opinion about the relationship between the choice of surgical approach and the constitutional parameters of the patient based on a study of postoperative results in reconstructions of the aorto -femoral segment. We believe that the patient's constitutional parameters are one of the key factors that should be taken into account when choosing a surgical approach.
Purpose of the study. Assessing the significance of the influence of the patient’s constitutional parameters on the development of life-threatening postoperative complications when using laparotomy and retroperitoneal approaches.
Materials and methods. The study included 284 patients who underwent aorto-bifurcation femoral bypass/prosthetics for lesions of the aorta and iliac arteries of types C and D according to the international classification TASC II. The patients were divided into groups according to the surgical approach used: group I (n = 160) - laparotomic approach, group II (n = 124) - retroperitoneal approach, according to C. Rob. In the groups, the number of development of life-threatening complications of stage III - IV was assessed according to the Clavien - Dindo classification and deaths. Between patients with and without the development of the above-described complications in groups I and II, the values of constitutional parameters were compared, which allow assessing the presence or absence of excess body weight and the type of visceral obesity of the patient, based on the patient’s skeletal structure: height, weight, body mass index, abdominal circumference, cost-iliac distance, epigastric angle, xiphoid-pubic distance.
Results. A comparative analysis of the total number of development of life-threatening complications and mortality did not show a significant difference between patients in the studied groups, however, the number of development of gastrointestinal complications in group II was significantly lower than in group I, and amounted to 1 (0.8%) vs 10 (6.2%) respectivelyclinical observations (p* = 0.019). The Kruskal-Wallis analysis revealed that the indicators: weight, BMI, abdominal circumference, costal - iliac distance and epigastric angle, have a significant difference between patients with and without life-threatening complications in groups I and II (p*** < 0.05), while height and xiphoid-pubic distance did not confirm the statistical significance of their influence on the development of such complications in the studied groups.
Conclusion. Constitutional parameters: weight, body mass index, costoiliac distance, abdominal circumference and epigastric angle have a statistically significant effect on the development of postoperative life-threatening complications when using laparotomy and retroperitoneal approaches. Based on the results of the study, a table was generated for selecting the optimal surgical approach based on an assessment of the patient’s constitutional parameters.