Results of surgical treatment in patients with critical ischemia of the lower limbs and complications of endovascular interventions

2017 ◽  
Vol 10 (1) ◽  
pp. 47
Author(s):  
A. V. Gavrilenko ◽  
A. A. Kravchenko ◽  
D. V. Shatalova
Keyword(s):  
Surgical Treatment ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Endovascular Interventions

A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta

2020 ◽  
Vol 28 (4) ◽  
pp. 506-513
Author(s):  
Alexander F. Kharazov ◽  
V. A. Kul'bak ◽  
Naida Minatullaevna Basirova
Keyword(s):  
Surgical Treatment ◽  
Arterial Pressure ◽  
Arterial Hypertension ◽  
Abdominal Aorta ◽  
Clinical Manifestations ◽  
Vascular Anomaly ◽  
The Body ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Infrarenal Abdominal Aorta

Aim. To demonstrate a case of treatment of a patient with a rare vascular anomaly hypoplasia of infrarenal abdominal aorta. On a clinical example of female patient U., 41 years of age, with critical ischemia of the lower limbs and diagnosis hypoplasia of the abdominal aorta made on the basis of the clinical and instrumental data, the manifestations, diagnostics and potentials of the successful surgical treatment of the given pathology were demonstrated. Conclusion. Clinical manifestations of hypoplasia of the aorta depend on localization of the lesion and involvement of renal arteries. The commonest clinical sign is arterial hypertension and symptoms associated with the elevated arterial pressure. Hypoplasia of the aorta may also be manifested by hypertrophy of the upper limbs in combination with poor development of muscles of the lower limbs. More aged individuals present with arterial insufficiency leading to clinically significant ischemia of the lower limbs. Thus, in the case described, the patient already had ischemic trophic ulcers of the lower limbs. Without treatment, secondary arterial hypertension and cardiac failure may lead a patient to early death. Today, irrespective of the etiology, the only effective method of treatment of this disease is surgery. In case of our patient, resection of the hypoplastic segment of the aorta and its prosthetics were performed. This permitted to restore circulation in the lower parts of the body and further led to complete healing of trophic ulcers of the shin and to normalization of the systemic arterial pressure.

scholarly journals PROGRESS IN SURGICAL TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA

2018 ◽  
Vol 25 (6) ◽  
pp. 14-18
Author(s):  
O. A. Alukhanyan ◽  
X. G. Маrtyrosya ◽  
I. V. Poluektova ◽  
V. A. Avakimyan
Keyword(s):  
Surgical Treatment ◽  
Pain Syndrome ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Bypass Patency ◽  
Thrombotic Complications ◽  
Male Patients

Aim. The study was conducted to expand the variety of ways for surgical treatment of chronic ischemia of lower limbs complicated by the involvement of the femoropopliteal and pedidial arterial segment. Materials and methods. The experience of surgical interventions in 43 male patients aged 52-75 suffering from chronic ischemia of lower limbs complicated by the atherosclerotic involvement of the femoropopliteal and pedidial segment has been summarized. According to the classification by A.V. Pokrovskiy, ischemia of the 3rd stage has been determined in 24 patients (55,8%), while ischemia of the 4th stage complicated by necrosis of the toes (critical ischemia) has been determined in other 19 patients (44,2%). All examined patients have undergone the reconstructive interventions using the prepared lateral subcutaneous vein of the upper extremity as a shunt.Results. During the first day after the operation, the regression of pain syndrome as well as the warming of the lower extremity was indicated in 93% of patients. In 8-12 days after the reconstructive operation, the patients have undergone the 15 necrectomy or toe amputation. In the nearest postoperative period (less than 6 months) no thrombotic complications in the reconstructed segment have been determined. Within the observation period from 6 months to 5 years the bypass patency has been preserved in 71% of patients; ischemia of the 2nd B type has been revealed in all patients with the preserved bypass patency by the clinical examination.Conclusion. Despite the “forced” character of usage of the prepared V. cephalica due to the absence of “traditional” venous shunts as well as the labor intensity of the method, it allows to expand the variety of ways for surgical treatment of patients suffering from chronic ischemia of lower limbs of the 3rd-4th stages complicated by occlusive involvements of the femoropopliteal and pedidial segment.

scholarly journals Surgical treatment of patients with critical ischemia of lower limbs originating from aortoiliac lesions and concomitant coronary artery disease

2015 ◽  
Vol 17 (1) ◽  
pp. 73
Author(s):  
A. N. Vachev ◽  
V. V. Sukhorukov ◽  
Ye. A. Surkova ◽  
A. D. Gureev ◽  
A. V. Krugomov ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Bypass Surgery ◽  
Lower Limbs ◽  
Hybrid Procedures ◽  
Aortobifemoral Bypass ◽  
Critical Ischemia ◽  
Artery Disease ◽  
Concomitant Coronary Artery Disease

The study focuses on the outcomes of surgical treatment of 236 patients with critical ischemia of lower limbs originating from aortoiliac lesions and concomitant coronary artery disease. All patients first underwent vascular surgery, with 158 of them having aortobifemoral bypass surgery and 78 - hybrid vascular procedures on the aortoiliac segment: open surgical revascularization of femoral arteries and angioplasty and stenting of iliac arteries. Critical limb ischemia was successfully treated in all patients. One patient died after aortobifemoral bypass surgery; no fatal outcomes were registered after hybrid procedures.

Use of intravenous alprostadil in patients with severe critical ischemia of the lower limbs

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 318-323
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E Machado-Duque
Keyword(s):  
Critical Limb Ischemia ◽  
Adverse Reactions ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Cross Sectional ◽  
Potential Benefits ◽  
Advanced Stages ◽  
Clinical Records

Objectives To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. Methods A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. Results Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. Conclusions Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.

scholarly journals ENDOTHELIAL FUNCTION AND MORPHOFUNCTIONAL STATE OF BLOOD CELLS IN THE BASINS OF THE ISCHEMIC LIMBS IN THE DIFFERENT TYPES OF SURGICAL TREATMENT OF ATHEROSCLEROSIS OBLITERANS

2011 ◽  
Vol 2 (1) ◽  
pp. 41-46
Author(s):  
I I Katelnitsky ◽  
S A Pleskachev ◽  
M A Burikov ◽  
A S Matsionis ◽  
P E Povilaytite
Keyword(s):  
Surgical Treatment ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Lower Limbs ◽  
Lumbar Sympathectomy ◽  
Treatment Implementation ◽  
Different Types ◽  
Red Blood Cell Membranes ◽  
Severity Of The Disease ◽  
Atherosclerosis Obliterans

The aim of the investigation was to study the morphological condition of blood cells in the basins of the ischemic limbs and their dynamics as a result of various types of surgical treatment. Implementation of combined surgical treatment has a more normalizing effect in comparison with isolated reconstructive surgical treatment. The use of lumbar sympathectomy in patients with occlusive lesions of arteries of lower limbs and varying degrees of ischemia reduces endothelial dysfunction and normalizes a number of parameters describing the morphology and functioning of red blood cells and platelets. There was detected the deformation of red blood cells indicating that the restoration of the plasticity of red blood cell membranes significally reduced the degree of agglutination of red blood cells. According to obtained data the influence of sympathectomy depends on the severity of the disease in general the highest efficiency is observed at the II and III degree of ischemia.

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 Compartment Syndrome Related to Patient Positioning in the Surgical Treatment of Urolithiasis

2021 ◽  
Author(s):  
Inés Laso-García ◽  
Fernando Arias-Fúnez ◽  
Gemma Duque-Ruiz ◽  
David Díaz-Pérez ◽  
Alberto Artiles-Medina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Percutaneous Nephrolithotomy ◽  
Rare Complication ◽  
Patient Positioning ◽  
Lower Limbs ◽  
Urinary Stones ◽  
Ureteral Stones ◽  
Lithotomy Position ◽  
American Society

The incidence of urolithiasis is progressively increasing worldwide, as is the surgical treatment of urinary stones. The most frequent surgery for urolithiasis is ureterorenoscopy, which is performed in the lithotomy position. This position is also used in the endoscopic approach to bladder stones. Lateral decubitus is rarely used in the treatment of urinary stones. In the case of complex kidney stones, the gold standard treatment is percutaneous nephrolithotomy. This surgery has traditionally been performed in the prone position. However, the use of the supine (Valdivia) position is increasing in recent times. Furthermore, the Galdakao-modified supine Valdivia position has been widely used for percutaneous nephrolithotomy since it was described by Ibarluzea et al. in 2007. Treatment of kidney and ureteral stones simultaneously is allowed in both supine positions. In addition, they allow the removal of encrusted stents and the easy placement of double J stents and, in the case of the Galdakao-modified supine Valdivia position, percutaneous nephrostomies. Compartment syndrome is a rare complication in the lithotomy position, but scarcely described in the supine position. This especially applies to the Galdakao-modified supine Valdivia position, in which the lower limbs are in moderate flexion, with the ipsilateral lower limb in a slightly lower position relative to the other. This complication can lead to skin necrosis, myoglobinuric renal failure, amputation, permanent neuromuscular dysfunction, and even death. Risk factors include Body Mass Index, male gender, obesity, increased muscle mass, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, lack of operative experience, significant bleeding during surgery, hypothermia, acidemia, combination general-spinal anesthesia, prolonged surgical time, systemic hypotension, ASA (American Society of Anesthesiologists) class or vasoconstrictor drugs. Therefore, compartment syndrome of the leg is a potentially devastating complication that must be suspected and treated through early decompression of the compartment by four compartment fasciotomy. Preventive measures reduce the incidence of this condition.

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