Endovascular surgery for critical ischemia of lower extremities with suppurative-necrotic lesion of the feet

2017 ◽  
pp. 4
Author(s):  
K. V. Lipatov ◽  
S. V. Permyakov ◽  
A. G. Asatryan ◽  
A. V. Borodin ◽  
V. K. Gostishchev
Keyword(s):  
Lower Extremities ◽  
Necrotic Lesion ◽  
Endovascular Surgery ◽  
Critical Ischemia

scholarly journals ТHE PLACE OF ENDOVASCULAR SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

2020 ◽  
pp. 94-98
Author(s):  
V. B. Goshchynsky ◽  
O. B. Lugovyj ◽  
S. O. Lugovyj ◽  
U. M. Herasimets
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Lower Extremities ◽  
The Elderly ◽  
Endovascular Surgery ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Ischemia Of The Limbs ◽  
Analysis Of Results ◽  
Late Postoperative Period

Summary. The purpose of the study. To determine the possibility of endovascular surgical interventions and their effectiveness in patients with critical ischemia of the limbs. Materials and methods. The object of research was 209 patients with critical ischemia of the limbs, ages 53 to 71 years, which made endovascular surgical interventions. The results. Analysis of results of endovascular surgery witness that balloon angìoplasty with stenting zone for reconstruction and balloon angìoplasty with paclitaxel give the smallest percentage of reocclusion and restenosis in the early and late postoperative period than balloon angìoplasty. Conclusions. 1. The use of endovascular surgical interventions is a promising method of treatment of critical ischemia of the lower extremities, especially in the elderly and senile. 2. In case of critical ischemia of the limbs should be used balloon angìoplasty with stenting or balloon angìoplasty with paclitaxel, based on the results of early and late postoperative period.

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 The analysis of database of registered diseases of peripheral arteries in Yekaterinburg

2019 ◽  
Vol 60 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Elena P. Burleva ◽  
Yu. V. Babushkina ◽  
D. A. Lobanova ◽  
T. A. Barkan
Keyword(s):  
Medical Records ◽  
Statistical Processing ◽  
Lower Extremities ◽  
Management Decision ◽  
Peripheral Arteries ◽  
Critical Ischemia ◽  
Number Of Patients ◽  
Target Values ◽  
Management Decision Making ◽  
Quality Of Medical Care

The study was carried out to analyze database of registered diseases of peripheral arteries in patients of Yekaterinburg during 2009-2013. The database of the territorial foundation of mandatory medical insurance of the Sverdlovsk region in 2009-2013 was used as study material. The number of registered cases of treatment of diseases of peripheral arteries was analyzed. The sampling of patients with diseases of peripheral arteries taking treatment in twenty-four-hours and day-time hospitals. The statistical processing was applied to all cases ranged by years: patients with compensated blood circulation, critical ischemia of extremities and mortification. The audit was applied to randomly selected 40 medical records of patients with diseases of peripheral arteries, receiving treatment in twenty-four-hours and day-time hospitals during 2014 and 50 medical records ofpatients with diseases ofperipheral arteries against the background of diabetes mellitus from register of the oblast podiatry consulting room. The total number of treated patients with diseases ofperipheral arteries in Yekaterinburg during five years made up to 31,309, including 19% ofpatients with diabetic affection of lower extremities. In twenty-four-hours hospital 12,716 (40.6%) patients were treated and 18,593 (59.4%) were treated in day-time hospital. The study established increasing in day-time hospitals number of patients with arteriosclerosis obliterans up to 1.8 times, with diabetic angiopathy up to 3.6 times. At increasing of number of treated patients number ofpatients with critical ischemia of lower extremities during 5 years decreased insignificantly and number of large amputations have a certain trend to decreasing (up to 2.5%). The study established deviations under application of medicinal therapy in patients with diseases of peripheral arteries at pre-specialized stage and absence of achievement of target values of main laboratory parameters. The database of registered diseases of peripheral arteries can be used as a tool for data analysis and further management decision making with purpose of enhancing quality of medical care of patients residing in municipality.

scholarly journals Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

2009 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Valeriy Afanas'evich Mitish ◽  
I A Eroshkin ◽  
Gagik Radikovich Galstyan ◽  
Lyudmila Petrovna Doronina ◽  
Yu S Paskhalova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Lower Leg ◽  
Diabetic Foot Syndrome ◽  
Diagnostic Tools ◽  
Critical Ischemia ◽  
Adequate Treatment ◽  
Patients With Diabetes ◽  
Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

Four-year follow-up of two patients on maintenance therapy with fondaparinux and mycophenolate mofetil for microthrombotic antiphospholipid syndrome

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 1003-1006 ◽  
Author(s):  
B W Baron ◽  
J M Baron
Keyword(s):  
Mycophenolate Mofetil ◽  
Maintenance Therapy ◽  
Antiphospholipid Syndrome ◽  
Warfarin Therapy ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Critical Ischemia ◽  
Intravenous Heparin ◽  
Small Cohort

Objectives We discuss two patients with antiphospholipid syndrome (APS) who presented with critical ischemia of both lower extremities due to arterial microthrombi. They received multimodality therapy emergently: anticoagulation, immunosuppression, and therapeutic plasma exchange (TPE). Then they were maintained on anticoagulation with fondaparinux and immunosuppression with mycophenolate mofetil (MMF), and were followed for 4 years. Methods Two patients with APS with ischemia and necrosis of their distal lower extremities were treated emergently with anticoagulation (intravenous heparin), immunosuppression (prednisone), and TPE. They were maintained on anticoagulation with fondaparinux and immunosuppression with MMF. Results Neither patient had recurrent microthrombotic disease during a 4-year follow-up. Conclusions As described in our small cohort, patients with APS who suffer from microthrombotic arterial disease may benefit from maintenance therapy of anticoagulation with fondaparinux and immunosuppression with MMF, an approach which may be worthy of further trial. Fondaparinux does not require attention to diet, monitoring, and cumbersome bridging that is typical of warfarin therapy. MMF provides immunosuppression while sparing the side effects of steroid treatment.

scholarly journals Treatment of critical limb ischemia in patients with multilevel arterial lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 474-478
Author(s):  
V. Shaprynskyi ◽  
Y. Gupalo ◽  
O. Shved ◽  
O. Nabolotnyi ◽  
D. Shapovalov
Keyword(s):  
Atherosclerotic Lesion ◽  
Lower Extremities ◽  
Main Group ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Optimal Method ◽  
Surgical Interventions ◽  
Limb Preservation ◽  
Arterial Lesions

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

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