RECONSTRUCTIVE SURGERY IN A PATIENT WITH CHRONIC THROMBOTIC OCCLUSION OF THE ABDOMINAL AORTIC ANEURISM FROM MINI-ACCESS (CASE REPORT)

Aim. The purpose of describing this clinical observation was to demonstrate the clinical and instrumental picture and tactics of reconstructive surgery in the development of combined ischemia of the large intestine and lower extremities due to thrombotic occlusion of the infrarenal aortic aneurysm.
Case. Patient R., 72 years old, was admitted to the clinic on 09/11/2020. with complaints of numbness in the toes of both feet, pain in the muscles of both thighs and legs, discomfort and bloating in the left abdomen, delayed bowel movements. After an additional examination in the hospital, the following clinical diagnosis was formulated: Atherosclerosis of the aorta and its branches. Thrombosis of the infrarenal aortic aneurysm. Thrombosis of the iliac arteries. Critical ischemia of the lower extremities. Essential hypertension of the II degree, erosive gastritis, ischemic colitis. 09/13/2020 the patient underwent surgery: Thrombectomy from the infrarenal aorta, aorto-femoral bifurcation prosthetics with a synthetic prosthesis with silver ions with replantation of the inferior mesenteric artery into the main branch of the prosthesis from a mini-access. Smooth postoperative course.
Conclusion. In the given clinical observation, long-term stenosing atherosclerosis of the aorta and iliac arteries in combination with essential hypertension led to the formation of an aneurysm of the abdominal aorta and was complicated by thrombosis. This clinical picture required a complete revascularization of all affected arterial basins: the left half of the large intestine, lower extremities. Carrying out a large volume of surgery using minimally invasive technology contributes to the restoration of the function of the intestines and lower extremities in the shortest possible time, as well as rapid physical and social rehabilitation of the patient.

1. Clinical angiology: Klinicheskaya angiologiya: Rukovodstvo dlya vrachej: T.1, 2 [A guide for doctors: T.1, 2 (under the editorship of A.V. Pokrovsky)]. M.: Medicine, 2004, 873 p. (In Russ)

2. Crawford J.D., Perrone K.H.,Wong V.W.,Mitchell E.L. et al. A modern series of acute aortic occlusson. J. Vasc. Surg., 2014, 59(4), рр. 1044–1050.

3. Mikhailov I.P., Kokov L.S., Isaev G.A. Lechenie bol’nyh s trombozom bryushnoj aorty [Treatment of patients with abdominal aortic thrombosis]. Surgery. Journal n.a. N.I. Pirogov, 2018, No. 3, рр. 54–58. (In Russ)