Planning of stages of a hybrid operation on iliofemoral arteries in critical lower limb ischemia using mathematical modeling

• Vaganov A.G.
• Nochnoy M.S.
• Lisitsky D.A.
• Gavrilenko A.V.

Abstract

Background. One of the main problems of hybrid interventions on lower extremity arteries with obliterating atherosclerosis is the decision-making as to the stages of manipulations within one operation.

Objective. This study aimed to improve the results of treating patients with lower limb critical ischemia by means of determining the sequence of stages of hybrid operations for lesions of the aortoiliac segment.

Patients and methods. Our study involved 226 patients who underwent hybrid surgery for critical lower limb ischemia at the Vascular Department of the City Clinical Hospital № 29 from 2018 to 2023. They were divided into 2 groups: Group 1 comprised 152 patients who underwent open intervention on femoral arteries as the first stage of a hybrid operation and Group 2 included 74 patients who underwent stenting of iliac vessels as the first stage. In order to retrospectively substantiate the sequence of stages of the hybrid operations, we used a mathematical model consisting in comparing the calculated total minimal diameter (d) of the lumens of the cross section of the femoral vessels, which would correspond to the clinical picture of critical limb ischemia, with the real one determined by means of CT angiography (d_CT). The obtained data were statistically analyzed using the SPSS Statistics 17.0 software.

Results. In Group 1, the immediate success of arterial reconstruction was noted in 144 (94.7%) patients, with in most cases d>d_CT and d=d_CT, as assessed retrospectively. In Group 2, the success was achieved in 69 (92.6%) patients, with the retrospective analysis showing d<d_CT in most cases. In the late postoperative period, amongst Group 2 patients with the ratio d>d_CT and d=d_CT, more frequently encountered were those with relapse of critical ischemia, a history of a large number of re-operations, and amputations (p<0.0005). Group 1 patients with the ratio d<d_CT were found to have a similar trend (p<0.0001).

Conclusion. The proposed mathematical model for determining the phasing of a hybrid operation on lower-limb arteries is effective in drawing up a plan of surgical intervention. When d>d_CT and d=d_CT, it is more effective to perform the open stage first, and when d<d_CT, the initially endovascular stage of the hybrid operation appears to yield better results.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Gavrilenko A.V.; development of mathematical model – Lisitsky D.A., Vaganov A.G., Nochnoy M.S.; statistical processing – Vaganov A.G., Nochnoy M.S.; draft manuscript preparation – Vaganov A.G., Lisitsky D.A.; manuscript revision – Gavrilenko A.V.

For citation: Vaganov A.G., Nochnoy M.S., Lisitsky D.A., Gavrilenko A.V. Planning of stages of a hybrid operation on iliofemoral arteries in critical lower limb ischemia using mathematical modeling. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 64–71. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-64-71

Keywords: hybrid surgery; hybrid revascularization; stenting; critical ischemia of the lower limbs; mathematical modeling in vascular surgery