[Prolonged endarterectomy in distal forms of arterial diseases of the lower extremities].
Six-year experience of surgical treatment of patients with critical lower limb ischemia due to a distal form of arterial lesion is presented. Surgical treatment was performed in extended occlusive lesion from inguinal fold to arteries of the calf and foot, and inadequate "ways of outflow". The king of arterial lesion did not permit the surgeon to perform typical bypass surgery or arterialisation of venous system with a traditional scheme. All the patients were candidates for amputation. For salvage of extremity 36 patients underwent prolonged semi-closed endarterectomy using special instrument which was supplemented with temporary arterio-venous fistula or popliteal-distal auto-venous bypass. In short-term period after surgery critical ischemia was eliminated in 25 (69%) patients. The rest of the patients underwent amputations. 5 years later cumulative safety of the extremities was 95% among patients with good short-term results. These variants of revascularizing surgery may be regarded as alternative to amputations in patients with critical limb ischemia due to distal lesions of lower limbs arteries.