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The authors consider the tactical features of transcutaneous endovascular angioplasty in 110 patients with multiple arterial occlusive and stenotic lesions of the pelvis and lower extremities. A total of 299 arteries were operated on and desobliteration of stenoses and occlusions were performed. Five procedures of transcutaneous endovascular angioplasty: via transfemoral antegrade, transfemoral retrograde, transfemoral contralateral, transpopliteal, and transaxillary accesses were used alone or in combination. The tactics of transcutaneous endovascular angioplasty was determined by the nature, site, and extent of lesions, as well as the status of the distal arterial bed. Clinical positive results of transcutaneous endovascular angioplasty were obtained in 94 (85.4%) patients. Complications following endovascular interventions were encountered in 5 (4.6%) cases.

The paper outlines the analysis of immediate and late outcomes of transcutaneous transluminal angioplasty (TTA) in 147 patients with atherosclerosis obliterans of the lower extremities. The study has revealed that age and dyslipidemia as TTA risk factors fail to affect the immediate outcomes in the early postoperative period. There is a positive correlation of the reocclusion time after TTA and the age and lipid metabolic disturbances in patients with atherosclerosis obliterans of the lower extremities in long-term periods. The paper provides strong evidence for that it is essential to correct dyslipidemias in order to make TTA results better in these patients.

Regional thrombolysis was performed in 62 patients with thrombosis of the aorta and arteries of the pelvis and lower extremities. The thrombolytics used were avelysin (20 patients) and celiase (42 patients). Complete lysis of the thrombi was recorded in 49 cases. After successful thrombolytic therapy balloon angioplasty of the revealed stenoses was carried out in 39 patients. After thrombolysis was completed 15 patients underwent various reconstructive operations which failed to produce an effect in 4 patients and the extremity was amputated. The complications of thrombolysis included hematomas at the site of catheterization of the arteries in 5 patients, distal embolism in 7, and an allergic reaction in one patient. The authors appraise the dependence of thrombolysis efficacy on the level, extent, and duration of the thrombotic occlusion.

The diagnostic potentialities of digital subtraction angiography (DSA) in diseases of the pelvic arteries and lower limbs were studied. Intravenous (iv) and intraarterial (ia) DSA were performed in 613 patients, among them were patients with obliterating atherosclerosis and endarteritis, thromboembolism, aneurysms and arteriovenous fistulas. Iv DSA provided good information for the solution of therapeutic and tactical problems in pelvic, femoral and popliteal arterial lesions but in 16% of the cases it gave no opportunity to assess the status of the crural arteries. Ia DSA was shown to be no inferior to routine arteriography in the visualization of the lower limb arteries. This method is economical, well tolerated by patients, permits the intensification of examination of patients with acute and chronic arterial pathology. It can be employed under outpatient conditions and in the early postoperative period.

Endovascular interventions were performed in 36 patients with multiple occlusive-stenotic lesions of main arteries of the pelvis and lower extremities. Femoral retrograde, antegrade and contralateral accesses were used. The importance to observe main principles of roentgenendovascular surgery is stressed such as organ preservation, atraumatic character, shorter time of staying of the patients at the hospital. The authors show advantages of one-step reestablishing of blood flow in all parts of the vascular bed subject to endovascular dilatation. The authors note that in certain clinical situations the roentgenendovascular surgery for multiple obliterating lesions must be performed in two steps and through different accesses.