A prospective study of the method of intraoperative luminescent spectroscopy in the application of isolated profundoplasty in hybrid surgery of critical ischemia of the lower limb

Introduction. Currently, it is relevant to develop new diagnostic criteria for assessing the condition of the deep femoral artery (DFA), in order to determine the possibilities of its use in various hybrid reconstructions for critical lower limb ischemia.

Aim: To determine the indications for isolated profundoplasty as the final stage of proximal hybrid reconstruction using the method of intraoperative luminescence spectroscopy.

Material and Methods. The prospective open-label non-randomized pilot study included 64 people operated at City Clinical Hospital No. 29 with a clinical diagnosis of “Obliterating atherosclerosis of the arteries of the lower extremities. Stenosis of the external iliac artery. Steno-occlusive lesion of the common femoral/superficial femoral artery. Stenosis of the deep femoral artery of the thigh. Chronic arterial ischemia of the III st.”, in the volume of proximal hybrid reconstruction, including isolated profundoplasty. The first group (n = 28) consisted of patients who had stenosis or occlusion of the mouth of the deep femoral artery, the second group (n = 20) – had diffuse lesion of the deep femoral artery, the third group (n = 16) – had a distal type of lesion of this artery. The first stage of the hybrid operation was stenting of the external iliac artery. The choice of further intraoperative tactics occurred as a result of an assessment of the anatomy and severity of the lesion of the deep femoral artery, by measuring the ankle-shoulder and hip-popliteal indices. All patients underwent intravascular luminescent spectroscopy intraoperatively using our technique to determine the luminescent compensation coefficient (CI). The follow-up period was 3 months. The end point of the study was thrombosis of the reconstruction zone. The SPSS 17.0 software was used for statistical data processing when comparing study groups.

Results. When comparing the obtained CI, a direct strong correlation was noted with a preoperatively determined hip-popliteal index (r = 0.76; at p < 0.005). When assessing the interval of the hip-popliteal index from 0.3 to 0.4; 4 patients with thrombotic complications in the early postoperative period and 3 patients with no thrombotic complications were evaluated. When correlating CI in these categories of respondents, the statistically significant differences in indicators were established: CI (without complications) = 0.46 (0.43; 0.50); CI (complicated) = 0.59 (0.58; 0.60); with p < 0.05. When studying preoperative deep femoropopliteal index in representatives of study groups 1 and 2 who had GPI in the range from 0.4 to 0.5, but differed in the outcomes of the late postoperative period, the statistical significance of differences in indicators was noted: Cl (without complications) = 0.44 (0.43; 0.46); Cl (complicated) = 0.61 (0.60; 0.62); at p < 0.05.

Conclusion. Intravascular luminescence spectroscopy is an important method of clarifying the intraoperative feasibility of performing isolated profundoplasty in addition to preoperative assessment of the degree of the hip-popliteal index.

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