Determination of Stages of Hybrid Reconstruction of Lower Limb Arteries Using Laser-Induced Ultraviolet Photoluminescence Spectroscopy
Authors:   City Clinical Hospital No. 29 named after N. E. Bauman, Vaganov Aleksey G. , Nochnoy Maksim S. ,   N. V. Sklifosovsky Institute of Clinical Medicine, Lisitskiy Dmitriy A. ,   City Clinical Hospital No. 29 named after N. E. Bauman, Gavrilenko Aleksandr V. ,   Petrovsky National Research Center of Surgery,   N. V. Sklifosovsky Institute of Clinical Medicine
Published: January 2025

INTRODUCTION: The main problem that influences the effectiveness of hybrid operations is a stage approach to manipulations within a single reconstruction. One of methods that determines both the patency of the major arteries and effectiveness of revascularization of a limb based on the depth and reversibility of ischemic alterations at the cell-tissue level is the method of UV luminescence spectroscopy.
AIM: To determine the sequence of the stages in hybrid reconstruction of the lower limb arteries depending on the functional state of the distal arterial bed registered by the method of laser-induced ultraviolet photoluminescence spectroscopy.
MATERIALS AND METHODS: The study included 51 patients with critical ischemia of the lower limbs who underwent a hybrid (simultaneous) intervention: stenting of the external iliac artery and femoropopliteal bypass surgery in the department of vascular surgery of Bauman City Clinical Hospital No. 29. The patients were divided into two groups. The first group (n = 24) included patients who underwent femoropopliteal bypass surgery as the first stage, and stenting of the external iliac artery as the second stage. In the second group (n = 17), the first stage was stenting of the external iliac artery, and the second stage was open reconstruction within the first day. The third, control group (n = 10), consisted of patients who underwent only stenting of the external iliac artery with good postoperative results. Chemiluminescence was registered using the device proposed by I. V. Moskalenko. The parameters were taken up before the surgery on the inner surface of the lower third of thigh, middle third of shin, rear surface of the foot. On days 2–5, this examination was repeated. Statistical processing of the data when comparing study groups was performed using SPSS Statistics 17.0 software.
RESULTS: When studying the luminescence spectrum in the preoperative period, a characteristic maximum of the signal was noted at 410 ± 20 nm wavelength (peak of NADH and NADPH) that changed to its minimum at 450 ± 15 nm wavelength (peak of hemoglobin). Successful arterial reconstruction was observed in 24 patients from the first group and 14 from the second group. In this category of patients, the intensity of luminescence in 380 nm–430 nm range was comparable, but at 440 nm–460 nm wavelengths, it was reliably lower in the second group (p < 0.05), which indicates better openness and compensation of ‘outflow pathways’ in this group. In the postoperative period, in patients with successful revascularization, the reduction of luminescence intensity was noted in all measurement ranges, which confirms improvement of blood supply to the limb. There was a strong positive correlation between changes in the ankle-brachial index and luminescence amplitude in the preoperative (r = 0.78 at p < 0.0001) and postoperative (r = 0.75 at p < 0.0001) period. With an increase in the parameters of the functional state of the limb and arterial patency, the amplitude of chemiluminescence decreases. In the early postoperative period, 3 patients developed thrombotic complications accompanied by an increase in luminescence amplitude above 2.5 × 105 photons. In patients with chemiluminescence amplitudes before the operation greater than 0.7 × 105 photons (at 410 nm frequency) and greater than 0.5 × 105 photons (at 450 nm frequency), of priority is the open stage to correct the ‘outflow pathways’ because of a high risk of thrombotic complications. Uncomplicated cases of group 2 were compared with group 3, created empirically. Luminescence amplitude before the operation, at which such identity of the groups was noted, was 0.35 ± 0.05 × 105 photons at 410 nm, and 0.22 ± 0.03 × 105 photons at 450 nm.
CONCLUSION: The method of laser-induced UV luminescence spectroscopy permits to determine the state of ‘outflow pathways’ on the lower limb, which can be used in determining the stages of hybrid reconstruction of the lower limb arteries.