PREVENTION OF COMPLICATIONS OF SURGICAL TREATMENT OF PATIENTS WITH OCCLUSION OF THE AORTOILIAC SEGMENT.

Abstract

Introduction: The relevance of studying this topic is confirmed not only by the high incidence of aortoiliac segment occlusions, but also by the difficulty of preventing complications after surgical treatment. These complications can range from local infectious processes to serious systemic disorders such as renal failure, cardiovascular complications, and even death.

Aim: to study the influence of concomitant pathologies on the outcome of surgical treatment with occlusion of the aortoiliac segment. Materias and methods. The study was conducted at the Semey Medical University. It was aimed at analyzing methods for minimizing complications in surgical treatment of patients suffering from aortoiliac segment occlusion. The study covered a wide range of aspects, from diagnostics to postoperative rehabilitation, and was implemented through a retrospective analysis of medical records of 300 patients who underwent open surgical treatment of this disease between September 2018 and September 2023.

Results: As part of a large clinical study, two groups of patients, each comprising 150 people, were compared. One group underwent preoperative drug correction of diabetes mellitus and chronic obstructive pulmonary disease (COPD), while the other group continued to receive standard treatment without additional corrections. During the analysis of postoperative complications, it was found that in the group of patients who underwent preoperative correction of comorbidities, complications were observed in 27 patients, which accounted for 18% of the total number. In contrast, in the group without such correction, postoperative complications were recorded in 51 patients, which is equal to 34%. Statistical analysis revealed a significant difference in the incidence of complications between the two groups (p=0.005, t=2.82), confirming the importance of preoperative optimization in reducing the risk of postoperative complications. Complications that arose after surgery included infectious manifestations such as wound infections and pneumonia, cardiovascular problems including myocardial infarction and cardiac arrhythmias, and thrombotic complications including deep vein thrombosis and pulmonary embolism (PE). For example, wound infections were observed in 13 cases among patients without correction and only in 6 cases among those who underwent correction. Pneumonia occurred in 19 cases in the non-corrected group and in 10 cases in the corrected group. These data indicate that preoperative optimization significantly reduces the risk of infectious complications after surgery.

Conclusions: The study provided valuable data on the impact of preoperative preparation, including medical management of diabetes mellitus and COPD, on surgical outcomes in patients with aortoiliac occlusion. Based on the results, it can be concluded that careful preoperative assessment and preparation play a key role in reducing the risk of complications and improving clinical outcomes. In particular, preoperative correction of concomitant diseases significantly improves the condition of patients, as evidenced by higher functional test results, improved glycemic control, and decreased blood pressure. This, in turn, reduces the frequency and severity of intra- and postoperative complications, and reduces overall mortality. Analysis of predictors of complications showed that the duration of surgery and concomitant diabetes mellitus significantly increase the risk of postoperative complications. This emphasizes the need to develop and implement new surgical and anesthetic approaches aimed at optimizing the duration of operations and more careful monitoring of the condition of patients with diabetes. The results of the study also indicate the importance of a multidisciplinary approach to the treatment of this category of patients, including vascular surgeons, anesthesiologists, therapists, endocrinologists, pulmonologists and other specialists. This allows for comprehensive preoperative preparation, adequate intraoperative management and high-quality postoperative monitoring. Overall, the results of this study provide a basis for the development of new treatment strategies for patients with aortoiliac segment occlusion aimed at improving clinical outcomes and quality of life of patients. Further prospective studies are needed to confirm the effectiveness of the proposed approaches and their implementation in clinical practice.