{"title":"新冠肺炎患者急性动脉疾病的外科治疗","authors":"A. Krasnikov, D. Maryan, Yuri Alborov, Daniela Stepanov, Y. Belov","doi":"10.17116/kardio202316021223","DOIUrl":null,"url":null,"abstract":"Objective. To study the efficiency of surgical treatment of acute arterial diseases in patients with COVID-19. Material and methods. There were 85 surgeries on the great arteries between January 2021 and October 2021. Fifty-four patients underwent 67 interventions on the lower limb arteries and 15 patients underwent 18 surgeries on the upper limb arter-ies. All patients were diagnosed with COVID-19 bilateral pneumonia and positive PCR with various CT grades of lung lesion. Indication for emergency surgical treatment was critical lower limb ischemia or acute lower limb ischemia associated with thrombosis/embolism of the main arteries. Mean age of patients was 74.4±2.2 years. Results. We performed the following interventions: thrombectomy from the lower limb arteries — 44 (51.8%) patients, endarter-ectomy from superficial femoral artery — 1 (1.1%), re-canalization and balloon angioplasty of tibial arteries — 1 (1.1%), hybrid operations — 6 (7%), thrombectomy from the upper limb arteries — 18 (21.1%), aortoiliac bifurcation replacement — 1 (1.1%), surgery for bleeding from the main arteries — 14 (16.8%) patients. All patients continued postoperative anticoagulation and an-tiplatelet therapy. In 3% of cases, we decreased amputation level to the middle third of the lower leg and preserved the knee joint. In early postoperative period, 20% of patients developed distal thrombosis with irreversible ischemia of the lower extremity that required amputation at the hip level. The mortality rate amounted to 43.4%. It was mainly associated with respiratory failure and volume of lung lesion. Conclusion. Surgical treatment of arterial thrombosis/embolism or critical ischemia is effective. However, treatment may be fol-lowed by certain complications including progression of COVID-19 viral pneumonia with respiratory failure and acute respiratory distress syndrome. Therefore, these patients require an individualized approach and collegial decision-making regarding emergency surgery. © 2023, Media Sphera Publishing Group. All rights reserved.","PeriodicalId":17701,"journal":{"name":"Kardiologiya i serdechno-sosudistaya khirurgiya","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical treatment of acute arterial diseases in COVID-19 patients\",\"authors\":\"A. Krasnikov, D. Maryan, Yuri Alborov, Daniela Stepanov, Y. Belov\",\"doi\":\"10.17116/kardio202316021223\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective. To study the efficiency of surgical treatment of acute arterial diseases in patients with COVID-19. Material and methods. There were 85 surgeries on the great arteries between January 2021 and October 2021. Fifty-four patients underwent 67 interventions on the lower limb arteries and 15 patients underwent 18 surgeries on the upper limb arter-ies. All patients were diagnosed with COVID-19 bilateral pneumonia and positive PCR with various CT grades of lung lesion. Indication for emergency surgical treatment was critical lower limb ischemia or acute lower limb ischemia associated with thrombosis/embolism of the main arteries. Mean age of patients was 74.4±2.2 years. Results. We performed the following interventions: thrombectomy from the lower limb arteries — 44 (51.8%) patients, endarter-ectomy from superficial femoral artery — 1 (1.1%), re-canalization and balloon angioplasty of tibial arteries — 1 (1.1%), hybrid operations — 6 (7%), thrombectomy from the upper limb arteries — 18 (21.1%), aortoiliac bifurcation replacement — 1 (1.1%), surgery for bleeding from the main arteries — 14 (16.8%) patients. All patients continued postoperative anticoagulation and an-tiplatelet therapy. In 3% of cases, we decreased amputation level to the middle third of the lower leg and preserved the knee joint. In early postoperative period, 20% of patients developed distal thrombosis with irreversible ischemia of the lower extremity that required amputation at the hip level. The mortality rate amounted to 43.4%. It was mainly associated with respiratory failure and volume of lung lesion. Conclusion. Surgical treatment of arterial thrombosis/embolism or critical ischemia is effective. However, treatment may be fol-lowed by certain complications including progression of COVID-19 viral pneumonia with respiratory failure and acute respiratory distress syndrome. Therefore, these patients require an individualized approach and collegial decision-making regarding emergency surgery. © 2023, Media Sphera Publishing Group. All rights reserved.\",\"PeriodicalId\":17701,\"journal\":{\"name\":\"Kardiologiya i serdechno-sosudistaya khirurgiya\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kardiologiya i serdechno-sosudistaya khirurgiya\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.17116/kardio202316021223\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kardiologiya i serdechno-sosudistaya khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/kardio202316021223","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Surgical treatment of acute arterial diseases in COVID-19 patients
Objective. To study the efficiency of surgical treatment of acute arterial diseases in patients with COVID-19. Material and methods. There were 85 surgeries on the great arteries between January 2021 and October 2021. Fifty-four patients underwent 67 interventions on the lower limb arteries and 15 patients underwent 18 surgeries on the upper limb arter-ies. All patients were diagnosed with COVID-19 bilateral pneumonia and positive PCR with various CT grades of lung lesion. Indication for emergency surgical treatment was critical lower limb ischemia or acute lower limb ischemia associated with thrombosis/embolism of the main arteries. Mean age of patients was 74.4±2.2 years. Results. We performed the following interventions: thrombectomy from the lower limb arteries — 44 (51.8%) patients, endarter-ectomy from superficial femoral artery — 1 (1.1%), re-canalization and balloon angioplasty of tibial arteries — 1 (1.1%), hybrid operations — 6 (7%), thrombectomy from the upper limb arteries — 18 (21.1%), aortoiliac bifurcation replacement — 1 (1.1%), surgery for bleeding from the main arteries — 14 (16.8%) patients. All patients continued postoperative anticoagulation and an-tiplatelet therapy. In 3% of cases, we decreased amputation level to the middle third of the lower leg and preserved the knee joint. In early postoperative period, 20% of patients developed distal thrombosis with irreversible ischemia of the lower extremity that required amputation at the hip level. The mortality rate amounted to 43.4%. It was mainly associated with respiratory failure and volume of lung lesion. Conclusion. Surgical treatment of arterial thrombosis/embolism or critical ischemia is effective. However, treatment may be fol-lowed by certain complications including progression of COVID-19 viral pneumonia with respiratory failure and acute respiratory distress syndrome. Therefore, these patients require an individualized approach and collegial decision-making regarding emergency surgery. © 2023, Media Sphera Publishing Group. All rights reserved.