Importance of Non-Invasive Study of Microcirculation in the Limb at Assessment Amputation Level in the Patients with Critical Ischemia (Review)

10.12737/5685 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 1-5
Author(s):  
Петриевский ◽  
S. Petrievskiy ◽  
Сорока ◽  
V. Soroka ◽  
Нохрин ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Blood Circulation ◽  
Critical Role ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Diagnostic Methods ◽  
Critical Ischemia ◽  
Amputation Level ◽  
Social Burden ◽  
Non Invasive

The development of modern vascular surgery is impossible without improvement of diagnostic methods of examination. The development of severe disorders of blood circulation in limbs, beyond compensation, ends up executing amputation. In the present review the authors considered one of the current problems of modern vascular surgery - high amputation in patients with critical ischemia of lower extremities, the truncation of the leg. According to the majority authors, the main reason for early purulent - necrotic complications in high amputation is the mistake of determining the level of amputation. This fact is accompanied by a sharp reduction in the duration and quality of life, which entails increasing social burden and increases economic costs of rehabilitation of patients. One of the possible solutions to this problem is to study the safety regulatory mechanisms resistive Department microcirculation (arterioles, precapillary sphincters and metarterioles). This article presents the available arsenal of vascular surgery: methods of diagnostics of the microcirculation. It is proved the critical role of non-invasive methods for measuring microcirculatory disorders in critical limb ischemia (CLI) when the doctors choose the level of amputation. It is a comprehensive assessment of blood circulation in tissues and tissue metabolism allows to giving an objective answer on the degree of ischemic damage to the tissue in occlusive diseases of arteries of lower extremities.

scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

scholarly journals Evaluation of the Efficacy of Surgical Treatment of Patients With Chronic Critical Ischemia of Lower Extremities at the Stage of Trophic Complications

2021 ◽  
Vol 9 (4) ◽  
pp. 545-550
Author(s):  
B. V. Kozlovsky ◽  
I. P. Mikhailov ◽  
G. A. Isayev ◽  
N. E. Kudryashova ◽  
O. V. Leshchinskaya
Keyword(s):  
Blood Circulation ◽  
Single Photon ◽  
Objective Assessment ◽  
Photon Emission ◽  
Lower Extremities ◽  
Emission Computed Tomography ◽  
Critical Ischemia ◽  
X Ray ◽  
Three Phase ◽  
X Ray Computed

Relevance. Chronic critical ischemia of the lower extremities (CCILE) in the stage of trophic complications is the final stage of diseases of the arteries of the lower extremities, leading to disability of patients and having a poor prognosis in terms of preservation of the lower extremities and mortality.Aim of study. Objective assessment of the efficacy of lower limb revascularization in trophic disorders.Material and methods. The analysis of treatment of 52 patients with stage IV CCILE (according to the classification of R. Fontaine and A.V. Pokrovsky) was carried out. Of these, 42 patients underwent three-phase scintigraphy combined with X-ray computed angiography on a hybrid apparatus. After the operation, this study was conducted in 37 patients.Results. Out of 52 patients, surgery for revascularization of the lower extremities was performed in 37 patients, 15 were not operated on. Out of 37 operated patients, improvement of blood circulation occurred in 32 (86.5%). Circulatory decompensation was observed in 5 patients (9.7%). Among non-operated patients, improvement of blood circulation occurred in 9 patients (17.3%), no effect or decompensation — in 5 (9.7%). Subjective improvement in the condition and decrease in the degree of ischemia corresponded to the improvement of microcirculation according to the data of three-phase scintigraphy.Conclusion.1. Revascularization of the lower extremities in patients with trophic disorders is an effective method of treating this pathology. Therefore, all patients with chronic ischemia threatening limb loss should be considered as candidates for revascularization.2. If the leg arteries or short occlusive or stenotic lesions of the main arteries are affected, such patients should be discussed together with specialists in endovascular surgery for endovascular treatment or joint intervention.3. Hybrid radiation method (three-phase scintigraphy and single-photon emission computed tomography, combined with X-ray computed angiography) is an objective method that reflects the state of peripheral circulation and microcirculation, and allows you to objectively assess the effectiveness of the treatment.

ENDOVASCULAR AND OPEN SURGICAL OPERATIONS OF CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

Vestnik ◽  
2021 ◽  
pp. 304-312
Author(s):  
Д.Д. Поцелуев ◽  
С.Е. Турсынбаев ◽  
Р.А. Сапарбаев ◽  
Е.А. Асылбеков ◽  
С.А. Илиев ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Comparative Analysis ◽  
Vascular Surgery ◽  
Lower Extremities ◽  
Clinical Results ◽  
Main Section ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Surgical Operations

В отделении сосудистой хирургии на протяжении 40 лет (с 1972 по 2012 гг.) было выполнено 9800 открытых операций у больных с КИНК II-IIIст, клинические результаты которых представлены в соответствующем разделе статьи для сравнительного анализа. В основном разделе работы рассматриваются результаты эндоваскулярных хирургических и открытых операций, выполненных у 1088 больных с критической ишемией нижних конечностей II-IIIст (КИНК) и сахарным диабетом (СД). Проведен сравнительный анализ показателей частоты ампутаций при открытых и эндоваскулярных хирургических вмешательствах (ЭХВ). Установлено преимущество ЭХВ в сравнении с открытыми операциями на основании снижения числа ампутаций после выполненных ЭХВ соотвественно с 52,3% до 3,5%. In the department of vascular surgery, for 40 years (from 1972 to 2012), 9800 open operations were performed in patients with CLI II-IIIst, the clinical results of which are presented in the corresponding section of the article for comparative analysis. The main section of the work examines the results of endovascular surgical and open operations performed in 1088 patients with critical ischemia of the lower extremities II-IIIst (CLI) and diabetes mellitus (DM). A comparative analysis of indicators of the frequency of amputations during open and endovascular surgical interventions (ECS) was carried out. The advantage of ECV in comparison with open operations was established on the basis of a decrease in the number of amputations after ECV performed, from 52.3% to 3.5%, respectively.

scholarly journals Combined Correction of Experimental Critical Ischemia of the Lower Extremities in a Rat Model

2021 ◽  
Vol 11 (3) ◽  
pp. 372-375
Author(s):  
Elvin E. Feyziev ◽  
Boris S. Sukovatykh ◽  
Alexander S. Belous ◽  
Maria A. Zatolokina ◽  
Elena V. Trubnikova ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Oral Administration ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Inguinal Ligament ◽  
Control Group ◽  
Critical Ischemia ◽  
Blood Microcirculation ◽  
Group 6 ◽  
Daily Oral Administration

The purpose of our research was to study the effectiveness of correcting experimental critical ischemia (CI) of the lower extremities with a combination of udenafil, simvastatin, and autologous bone marrow mononuclear cells (ABMMC). Methods and Results: The experiments were carried out on 24-month-old Wistar rats, weighing 220–250g. The animals were randomized by sex and weight. Groups were formed according to the manipulations carried out during the operations. The animals were divided into 7 groups, each with 20 animals: Group 1 included intact animals; Group 2 - falsely operated animals; Group 3 (control group) - animals with simulated CI without treatment; Group 4- animals with CI and monotherapy with udenafil (daily oral administration of 8.6mg/kg for 28 days); Group 5 - animals with CI and simvastatin monotherapy (daily oral administration of 1.71mg/kg for 28 days); Group 6 - animals with CI and monotherapy with ABMMC (parenterally, once on Day 7 after modeling CI, 50μl at 4 points and, paravasally, above the inguinal ligament in the area where the lateral artery leaves the artery enveloping the femur from the internal iliac artery; in the area of the superficial artery that bends around the iliac bone under the inguinal ligament; into the area of origin of the muscular branch of the femoral artery r. muscularis, the place of attachment of the comb and long adductor muscles of the thigh; in the upper third of the gastrocnemius muscle]); Group 7 - animals with CI and combination therapy (udenafil and simvastatin drugs were administered intragastrically 0.86 mg/kg, once a day, for 7 days) and one-time parenteral administration of ABMMC, according to the same scheme as in Group 6. On Days 21 and 28 of the experiment, the level of blood microcirculation was determined in the muscles of the rat leg; for this, laser Doppler flowmetry was used. For further morphometric assessment of the leg muscles, they were removed. Preparations for morphometric analysis were prepared according to the standard technique with Van Gieson staining, as well as H&E. Our study demonstrated the effectiveness of combination therapy with udenafil, simvastatin, and ABMMC to correct critical lower limb ischemia in rats. The severity of morphological changes on the background of this combination was minimal, compared to the findings of other study groups, and the level of blood microcirculation in the ischemic zone on Day 28 was, significantly, 1.9 times higher than in animals of the control group. The results obtained allow us to recommend the use of the investigated combination (udenafil+simvastatin+ABMMC) for the treatment of patients with critical limb ischemia, both in outpatient and inpatient practice.

scholarly journals Radionuclide Patterns of Ischemia in Acute Occlusive Diseases of Main Arteries of Lower Extremities

2019 ◽  
Vol 8 (3) ◽  
pp. 257-265
Author(s):  
N. Y. Kudryashova ◽  
O. G. Sinyakova ◽  
I. P. Mikhaylov ◽  
E. V. Migunova ◽  
O. V. Leshchinskaya
Keyword(s):  
Early Stage ◽  
Clinical Signs ◽  
Arterial Occlusion ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Diagnostic Methods ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Acute Thrombosis ◽  
Atherosclerotic Lesions

Relevance The problem of diagnosing and treating patients with acute ischemia of the extremities against the background of thrombosis and atherosclerotic lesions of the main arteries remains very complex task and requires the use of various diagnostic methods, and the leading one is radiation diagnostics.The aim of the study . The development of radionuclide patterns of acute lower limb ischemia and assessment of the treatment efficacy in angiosurgical patients using three-phase scintigraphy. Material and methods The radionuclide method was performed to examine 264 patients with acute thrombosis of the main arteries against the background of atherosclerotic lesions of the lower extremities arteries and clinical signs of acute ischemia of the lower extremities of I-III degree according to the classification of I.I. Zatevakhin.Results We defined quantitative and visual signs of acute ischemia, designed radionuclide semiotics, which allowed to detail the damaged tissue of lower extremities and evaluate the efficacy of the conservative or surgical treatment. The study contains clinical examples of patients with varying degrees of acute limb ischemia.Conclusion The developed radionuclide patterns of acute ischemia in thrombosis of main arteries of the lower extremities allowed to determine the level of arterial occlusion and the degree of acute ischemia, identify the areas of lack of blood supply and necrosis with no clinical signs at an early stage of formation and optimize the treatment strategy.

scholarly journals Improvement of surgical treatment of patients with critical ischemia of the lower extremities

2017 ◽  
Vol 4 (2) ◽  
pp. 455
Author(s):  
Shavkat Karimov ◽  
Akmal Irnazarov ◽  
Uktamkhon Askarovich Asrarov ◽  
Ulugbek Alijanov ◽  
Abdurasul Yulbarisov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Endarterectomy ◽  
Clinical Manifestations ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Critical Ischemia ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Associated Lesions ◽  
Reconstructive Operations

Background: The choice of tactics of surgical treatment in patients with lesions of the femoral-popliteal-tibial segment with the CILE is the actual problem, which is far from being solved. Aim of the study was to found improved treatment of patients with critical ischemia of the lower extremities by improving the surgical approach.Methods: 79 patients with critical ischemia of the lower extremities with lesions of the carotid and coronary arteries were observed and surveyed. To determine the tactics of treatment of these patients, we used non-invasive methods of imaging vessels, and only with probable therapeutic purposes used the contrasting of the vessels.Results: The used treatment allowed reducing the number of complications to a minimum. Among observable patients, in one case was determined acute myocardial infarction. 19 (24%) patients with stenosis and CILE managed to achieve regress of clinical manifestations of lower limb ischemia with medical therapy. In 12 (63.1%) patients were completed the installation of long catheter for intra-arterial catheter therapy, after that we performed carotid endarterectomy. Of these, 9 (47.3%) patients at 7 days underwent reconstructive operations on arteries of the lower extremities. In 5 (26.3%) patients after carotid endarterectomy, endovascular interventions implemented at ALE.Conclusions: The suggested diagnostic low and stages of surgical interventions significantly increase the detection of associated lesions of other arterial basins and expands the indications for surgical treatment with the use of combined interventions.

The Utility of Non-invasive Tests for Detection of Previous Proximal-vein Thrombosis

1995 ◽  
Vol 73 (04) ◽  
pp. 592-596 ◽  
Author(s):  
Sabina Villalta ◽  
Paolo Prandoni ◽  
Alberto Cogo ◽  
Paola Bagatella ◽  
Andrea Piccioli ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Femoral Vein ◽  
Clinical Score ◽  
Diagnostic Methods ◽  
Popliteal Vein ◽  
Venous Reflux ◽  
Study Objective ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
The Common

SummaryBackground. Despite the availability of several diagnostic methods for the detection of deep-vein thrombosis (DVT), the identification of previous episodes of DVT remains a diagnostic challenge.Study objective. To assess the reliability of a combination of a standardized clinical score with three non-invasive tests: compression ultrasonography (CUS), Doppler ultrasound (DUS), and photoplethysmography (PPG), in determining the presence or the absence of previous proximal DVT.Methods. One hundred consecutive unselected outpatients were identified, who had undergone contrast venography six to nine years previously because of the clinical suspicion of DVT (confirmed in 43). They were blindly reinvestigated by a panel of trained operators unaware of venography results. They underwent a clinical evaluation of the lower limb, by applying a standardized score to five symptoms and six signs (grading each item from 0 to 3); a PPG test to determine the venous refilling time; a DUS test to determine the venous reflux separately in the common femoral and the popliteal vein; and a CUS test to determine vein compressibility in the same regions.Results. An abnormal CUS test and/or the demonstration of venous reflux in the popliteal region and/or a high clinical score (≥ 8) identified twenty-four of the 43 (56%) DVT + patients with a specificity of 89%. The combination of normal CUS with the absence of venous reflux in both the common femoral and popliteal vein and a low clinical score excluded previous thrombosis in 45 (79%) of the 57 DVT- patients (negative predictive value, 78%). Abnormal venous reflux in the isolated common femoral vein did not reliably predict the presence or absence of previous DVT. However, this occurred in only 13 (13%) patients. The PPG determination of venous refilling time did not improve the results obtained with the other tests.Conclusions. The combination of a standardized clinical evaluation with the results of CUS and DUS can reliably diagnose or exclude previous proximal-vein thrombosis in almost 90% of patients with previous episodes of suspected DVT.

Diagnosis of helicobacter pylori infection: problems and prospects

2020 ◽  
pp. 54-59
Author(s):  
A. S. Molostova ◽  
N. S. Gladyshev ◽  
A. V. Svarval ◽  
R. S. Ferman ◽  
A. B. Karasyova ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Urease Activity ◽  
Diagnostic Methods ◽  
Study Group ◽  
Biochemical Method ◽  
Antimicrobial Drugs ◽  
Non Invasive ◽  
Number Of Patients ◽  
Pcr Method ◽  
Positive Results

(HP) infection was performed using invasive and non-invasive methods. The study group consisted of 95 patients with dyspepsia. HP infection was detected in 47 patients (49.4 %). The expediency of using a set of diagnostic methods for detecting HP (PCR, immunochromatographic, bacteriological and method for determining urease activity) is proved. Most often (100 %) in patients HP infection was detected in biopsies using the PCR method. Somewhat less frequently it was detected when examining biopsies with an invasive biochemical method (AMA RUT Reader) (82 %) and fecal immunochromatographic method (83 %). Despite the fact that helicobacteriosis was detected bacteriologically in a small number of patients (24 %), this method is of particular value, since it allows you to assess the sensitivity to antimicrobial drugs and probiotics, and does not give false positive results.

Non-Invasive Distinction of Non-Alcoholic Fatty Liver Disease using Urinary Volatile Organic Compound Analysis: Early Results

2015 ◽  
Vol 24 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Ramesh P. Arasaradnam ◽  
Michael McFarlane ◽  
Emma Daulton ◽  
Erik Westenbrink ◽  
Nicola O’Connell ◽  
...  
Keyword(s):  
Liver Disease ◽  
Pilot Study ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Diagnostic Methods ◽  
Screening Methods ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Volatile Organic ◽  
Alcoholic Fatty Liver Disease

Background & Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) is the commonest cause of chronic liver disease in the western world. Current diagnostic methods including Fibroscan have limitations, thus there is a need for more robust non-invasive screening methods. The gut microbiome is altered in several gastrointestinal and hepatic disorders resulting in altered, unique gut fermentation patterns, detectable by analysis of volatile organic compounds (VOCs) in urine, breath and faeces. We performed a proof of principle pilot study to determine if progressive fatty liver disease produced an altered urinary VOC pattern; specifically NAFLD and Non-Alcoholic Steatohepatitis (NASH).Methods: 34 patients were recruited: 8 NASH cirrhotics (NASH-C); 7 non-cirrhotic NASH; 4 NAFLD and 15 controls. Urine was collected and stored frozen. For assay, the samples were defrosted and aliquoted into vials, which were heated to 40±0.1°C and the headspace analyzed by FAIMS (Field Asymmetric Ion Mobility Spectroscopy). A previously used data processing pipeline employing a Random Forrest classification algorithm and using a 10 fold cross validation method was applied.Results: Urinary VOC results demonstrated sensitivity of 0.58 (0.33 - 0.88), but specificity of 0.93 (0.68 - 1.00) and an Area Under Curve (AUC) 0.73 (0.55 -0.90) to distinguish between liver disease and controls. However, NASH/NASH-C was separated from the NAFLD/controls with a sensitivity of 0.73 (0.45 - 0.92), specificity of 0.79 (0.54 - 0.94) and AUC of 0.79 (0.64 - 0.95), respectively.Conclusions: This pilot study suggests that urinary VOCs detection may offer the potential for early non-invasive characterisation of liver disease using 'smell prints' to distinguish between NASH and NAFLD.

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