The use of ultrasound angioscanning in assessing the results of arterial reconstructions of the infrainguinal segment

Introduction. In accordance with the Russian National Clinical Guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities, ultrasound is recommended for regular monitoring of the vascular reconstruction area in the postoperative period, with a frequency of every six months.

The purpose of the study. To evaluate the immediate results of arterial reconstructions of the infrainguinal segment using ultrasound.

Materials and methods. The work is based on the results of an examination of 203 patients with atherosclerosis of the arteries of the lower extremities who underwent open and hybrid arterial reconstructions on the infrainguinal segment in the Department of Vascular Surgery of the N.I. Pirogov State Clinical Hospital No. 1 in 2025. All patients (n=203, 100 %) underwent a control ultrasound scan of the arteries of the lower extremities and the vascular reconstruction zone on the day after surgery. An expert ultrasound examination with the determination of velocity parameters in the area of vascular reconstruction, proximal and distal to it, was performed in 167 cases (82,3 %).

Research results and discussion. On the 1st day of the subcutaneous period, the arterial reconstruction zone was completely passable in 198 patients (97,5 %). Shunt thrombosis was diagnosed in 5 cases (2,5 %) after FPB, including in combination with BAP of the arteries of the legs. All patients underwent thrombectomy from the femoral-popliteal shunt, supplemented by: – Reconstruction of the arteries of the tibia (in 2 cases); – BAP with EIA stenting (in 1 case); – BAP with stenting of the distal anastomosis of FPB and PA (in 1 case); – EAE from CFA and DFA (in 1 case).

Residual hemodynamically significant stenoses in the iliac segment were detected in 6 patients (2,9 %). At the same time, the ratio of intravenous peak systolic blood flow velocity to prestenotic in these patients ranged from 3,3 to 3,9. All patients underwent iliac segment stenting in order to prevent early vascular thrombosis. Residual hemodynamically insignificant stenoses on both the iliac and infra-lingual arterial segments were detected in 12 patients (5,9 %). At the same time, the ratio of intravenous peak systolic blood flow velocity to prestenotic in these patients ranged from 2,1 to 2,9. In order to prevent early thrombosis of vascular reconstruction, all patients were prescribed dual antiplatelet therapy (Aspirin + Clopidogrel) or monotherapy (Aspirin) in combination with Rivaroxaban 2,5 mg x 2 r/ day.

Conclusion. In order to evaluate the arterial reconstruction performed on the infrainguinal segment, identify residual changes and residual defects in the arterial bed for the subsequent prevention of postoperative thrombosis, in the early postoperative period, it is recommended to perform an expert ultrasound examination to determine the velocity parameters in the area of vascular reconstruction, proximal and distal to it, assessment of the morphological substrate of arterial lesion, the ratio of peak systolic blood flow rate (intravenous to prestenotic).

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