Possibilities of hybrid technologies in arterial surgery of the infrainguinal segment in critical limb ischemia: practical examples

Introduction. Critical lower limb ischemia is an ischemia that threatens the loss of a limb and most often develops with multiple atherosclerotic lesions of the arteries of the lower extremities, as well as with thrombosis of previously performed vascular reconstructive interventions. Hybrid arterial reconstructions combining both open and endovascular technologies with the possibility of restoring several arterial segments of the affected limb at once seem to be a promising area of surgery for critical lower limb ischemia, however, there are many contradictions in this approach. To date, there is no clear standardization and indications for hybrid operations on the arteries of the lower extremities, and there are no criteria for the stages of such interventions. In addition, performing hybrid operations requires a trained vascular, endovascular team and a hybrid operating room. The assessment of the long-term results of hybrid operations remains a matter of debate. The article provides practical examples highlighting the possibilities of hybrid technologies in arterial surgery of the infrainguinal segment in critical ischemia, including thrombosis of previously performed vascular reconstructions. Materials and methods. Three clinical examples are given demonstrating the effectiveness of hybrid reconstructions in patients with critical lower limb ischemia. Results. In the above clinical examples, hybrid reconstructions made it possible to restore blood flow in the infrainguinal segment and to stop the phenomena of critical ischemia of the affected limb in patients with a pronounced comorbid background, without resorting to longer and more traumatic bypass and resuscitation operations. Conclusion. In the above clinical examples, hybrid reconstructions made it possible to restore blood flow in the infrainguinal segment and to stop the phenomena of critical ischemia of the affected limb in patients with a pronounced comorbid background, without resorting to longer and more traumatic bypass and resuscitation operations.