IMPROVEMENT OF THE RESULTS OF OPERATIONS ON AORTO-FEMORAL SEGMENT FROM MINI-ACCESS BY THE USAGE OF THE PROGRESSIVE WIDENING

The increase of the number of patients with atherosclerosis of the aorta leads to a steady growth of the number of operations on aorta-femoral segment. In this regard, Federal programs of Federal funding are created for treatment of this disease. However, a high rate of mortality in cases of standard operations causes surgeons to minimize the volume of surgical treatment. The method of operation of the aorta from mini-access is studied enough, however, there are some problems, such as conversion of the access, intraoperative complications. The aim of this study is to improve the results of operations of the aorta from the mini-access by the usage of the progressive widening of the access. The analise of the results of reconstructive operations by mini-access from 2005 to 2009 shows a very high percentage (18.2%) of conversions. The main reason of conversions (50%) is the necessity of exposure of the aorta in the proximal direction until the level of the renal arteries that was impossible in the conditions of the standard mini-access. The widening of the standard minilaparotomy for 1.5 cm in proximal direction significantly improves the conditions of the operation, and creates good conditions for the formation of the proximal anastomosis immediately below the renal arteries. There was studied the possibility of widening of the standard mini-access in the proximal direction on dead bodies. The study included 30 dead bodies which were divided into two groups. There were analized the angle of operative actions, the inclination angle of the axis of operative actions, the area of availability of the standard mini-access (group 1, n = 30) and its widening in the proximal direction for 2 cm (group 2, n = 30). The study revealed that the usage of the progressive widening of the mini-access has greatly improved the spatial relations in the wound.

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