LONG-TERM RESULTS OF REVASCULARIZATION OF THE LOWER EXTREMITIES IN PATIENTS WITH CRITICAL ISCHEMIA AND DIABETES MELLITUS WITH LOCALIZATION OF THE OCCLUSIVE-STENOTIC PROCESS IN THE FEMORAL AND POPLITEAL ARTERIES

BACKGROUND: Diabetic foot ulcer (DFU) is a dangerous complication of diabetes mellitus (DM), which can lead to the development of chronic wounds and amputations. Recombinant human epidermal growth factor (rhEGF) can be used as an adjuvant treatment for chronic wounds resistant to standard treatment. Studies have demonstrated its clinical efficacy, however, there is insufficient information on the long-term results of treatment, its safety and the effect on the progression of diabetes complications, adverse cardiovascular events and the development of cancer.AIM: To assess the long-term results of rhEGF therapy for trophic foot ulcers in individuals with multiple complications of diabetes.METHODS: The study included 20 patients with type 1 and type 2 diabetes and various forms of DFS without critical ischemia, who had previously been treated with DFS using rhEGF in order to assess the general condition, progression of microand macrovascular complications of diabetes, adverse cardiovascular events, the development of cancer and the quality of life.RESULTS: There was a statistically significant difference between the area of wound defects, the percentage of granulation tissue that filled the wound defect, before the start of rhEGF treatment and at the time of discharge from the hospital (p <0.05). During treatment with rhEGF, mild adverse events were observed in 35%. Complete epithelialization of wounds in most patients occurred in 3 [2; 4] months. In 11.76%, the wound was not completely epithelialized. Relapse occurred in 5.8% due to non-compliance with limb unloading. Minor amputation was performed in 1 patient. Progression of diabetic retinoand nephropathy was revealed in 23.5%. 11.76% suffered myocardial infarction of unknown age, 1 patient (5.88%) suffered acute cerebrovascular accident. Serious adverse events in the form of PE with a fatal outcome and critical ischemia of the lower limb were recorded in 5.8%.CONCLUSIONS: As a result of the study of long-term results of rhEGF treatment of chronic foot wounds, a low percentage of relapses and small amputations, the absence of high amputations and oncological diseases, the development of serious adverse events in 2 patients, the progression of diabetic retinoand nephropathy in 4 patients, the development of IM of unknown age in 2 patients was recorded. and stroke in 1 patient after rhEGF therapy.

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Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽

10.1024/0301-1526/a000151 ◽

2011 ◽

Vol 40 (6) ◽

pp. 474-481 ◽

Cited By ~ 1

Author(s):

Radak ◽

Babic ◽

Ilijevski ◽

Jocic ◽

Aleksic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Limb Salvage ◽

Iliac Artery ◽

Graft Patency ◽

Long Term Results ◽

Surgical Reconstruction ◽

Safe Procedure ◽

Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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Long-term results after the application of the high-frequency endovenous electric welding on the trombosed great saphenous veins of lower extremities according to morphological and ultrasonography data

Surgery of Ukraine ◽

10.30978/su2019-3-46 ◽

2019 ◽

Vol 0 (3) ◽

pp. 46-50

Author(s):

S. І. Savoliuk ◽

R. А. Herashchenko ◽

V. А. Khodos ◽

V. S. Horbovets ◽

A. Yu. Glagoleva

Keyword(s):

High Frequency ◽

Lower Extremities ◽

Long Term Results ◽

Electric Welding ◽

Saphenous Veins

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Long-term results of revascularization post-myocardial infarction patients with diabetes mellitus type 2

Bulletin of Pirogov National Medical & Surgical Center ◽

10.25881/bpnmsc.2019.84.89.003 ◽

2019 ◽

Vol 14 (1) ◽

pp. 15-21

Author(s):

Ya.K. Rustamova ◽

G.G. Imanov ◽

V.A. Azizov ◽

D.A. Maksimkin ◽

A.G. Faybushevich

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Diabetes Mellitus Type 2 ◽

Diabetes Mellitus Type ◽

Post Myocardial Infarction ◽

Long Term Results ◽

Patients With Diabetes

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Long-term results of perivascular decompression of the great vessels of the lower extremities in the treatment of obliterating endarteritis

Kazan medical journal ◽

10.17816/kazmj62191 ◽

1985 ◽

Vol 66 (6) ◽

pp. 421-424

Author(s):

V. N. Medvedev ◽

V. N. Podolsky

Keyword(s):

Lower Extremities ◽

Long Term Results ◽

Great Vessels

There is an assumption that an important role in the occlusive process of the great arteries of the leg and foot in obliterating endarteritis is played by the factor of extravasal compression associated with pathological degeneration of paravasal tissue.

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Long-Term Results of the RAPCO Trials

Circulation ◽

10.1161/circulationaha.119.045427 ◽

2020 ◽

Vol 142 (14) ◽

pp. 1330-1338 ◽

Cited By ~ 4

Author(s):

Brian F. Buxton ◽

Philip A. Hayward ◽

Jai Raman ◽

Simon C. Moten ◽

Alexander Rosalion ◽

...

Keyword(s):

Diabetes Mellitus ◽

Radial Artery ◽

Graft Failure ◽

Internal Thoracic Artery ◽

Patient Survival ◽

Hazard Ratio ◽

Long Term Results ◽

Survival Estimate ◽

To Receive

Background: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV). Methods: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or <60 years of age if they had diabetes mellitus) were randomized to receive RA or free RITA graft on the second most important coronary target. In RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients ≥70 years of age (or ≥60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat. Results: In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23–0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30–0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15–1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47–1.22]). Conclusions: The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475488.

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Anatomic and surgical features of lower extremities blood vessels in case of major veins dysplasia in children with various type and severity of the disease according to data of contrast flebography

Pediatrician (St Petersburg) ◽

10.17816/ped11225-32 ◽

2020 ◽

Vol 11 (2) ◽

pp. 25-32

Author(s):

Mikhail V. Azarov ◽

Dmitry D. Kupatadze ◽

Viktor V. Nabokov ◽

Suren M. Kocharyan

Keyword(s):

Blood Vessels ◽

Soft Tissues ◽

Vascular Malformations ◽

Low Cost ◽

Lower Extremities ◽

Surgical Anatomy ◽

Long Term Results ◽

Severity Of The Disease ◽

Medical University

Dysplasia of the main veins (DMV) is known by the names of the authors who described this pathology as Klippel Trenone syndrome. The clinical picture of Klippel Trenone syndrome (CTS) in the classical version is characterized by a triad of symptoms: vascular spots, varicose atypical veins, hypertrophy of soft tissues and bones with an increase in the volume and length of the affected limb. The incidence of this defect from all vascular malformations is 49.6%. To diagnose a malformation, ultrasound is used Dopplerography, MRI and MSCT with contrast, ascending venography. Vasocontrast methods reveal various options for surgical anatomy of the veins of the affected limbs. To assess the anatomy of deep veins, we used upward contrasting, since we consider this species to be more accurate and low-cost. The study is based on the results of examination and treatment of 200 patients. Long-term results were analyzed in 108 patients with congenital malformations of the vessels of the lower extremities aged 1 year to 18 years, who were in the angiomicrosurgical department of the Pediatric Medical University from 2005 to 2015. Patients were divided into 2 groups: the embryonic type 70 people (of which 42 boys and 28 girls), and the fetal type 38 people (16 of them boys, 22 girls). In this paper, we analyze the results of ascending phlebography of the extremities, which is considered the gold standard for examining vein malformations. Contrast phlebography in 108 patients with dysplasia of the main veins, hypo- and dysplasia of segments of the deep and superficial veins were detected 63%; atypical location of superficial or deep veins with the presence of congenital pathways of the collateral outflow 30%, aplasia of the veins 7%. Conclusions: phlebography data accurately determine the surgical anatomy of blood vessels in patients with dysplasia of the main veins. The data obtained during the ascending phlebography, in almost 100% of cases coincide with intraoperative data thus allowing the development of optimal tactics of operations in the veins, and also scrutinize the pathology of musculoskeletal system.

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