scholarly journals Long-term results of proximal and distal reconstructions in patients with lower limb arteries diffuse lesions and diabetes mellitus

2021 ◽  
Vol 25 (4) ◽  
pp. 271-281
Author(s):  
Leo A. Bockeria ◽  
Valery S. Arakelyan ◽  
Vasil G. Papitashvili ◽  
Shalva Sh. Tsurtsumiya
Keyword(s):  
Lower Limb ◽  
Bypass Surgery ◽  
Lower Extremities ◽  
Severe Form ◽  
Primary Patency ◽  
Long Term Results ◽  
Reconstruction Method ◽  
Transcutaneous Oxygen ◽  
Group 1

Relevance . Treatment of diffuse lesions of the arteries of the lower extremities is often reduced to primary amputation at the hip level, since the healing of trophic ulcers is not guaranteed during arterial reconstruction. Profundoplasty without distal bypass surgery can be considered an alternative method. The aim of this study is to compare the long-term results of distal shunting and isolated profundoplasty in patients with diffuse lesions of the lower limb arteries and trophic ischemic ulcers. Materials and Methods . The study included 86 patients with diffuse lesions of the lower limb arteries. There were 52 (60.4%) men and 34 (39.6%) women. The average age was 67.3 16.8 years. All patients had diffuse lesions of the arteries below the pupar ligament, the state of the lower leg arteries was 5-8.5 points on the Rutherford scale, in all cases there were trophic ulcers. Group 1 included 48 patients who underwent reconstruction of the leg arteries. Group 2 consisted of 38 individuals who had limited intervention with endarcteriotomy from common femoral and deep femoral arteries. Results and Discussion . Amputations at the hip level were performed within a year in 11 (23.4%) patients of group 1 and in 3 (6.3%) patients within 30 days after surgery. Thus, 14 (29.7%) patients lost their limbs. A comparative analysis revealed that the group of patients with amputations had a more severe form of diabetes (p = 0.003), an outflow score on the Rutherford scale (p 0.001), and lower transcutaneous oxygen tension values before and after surgery. Within 12 months after the bypass surgery, the primary patency of the shunts was 65.9% (thrombosis occurred in 16 patients). Conclusion . The preservation of the limb in patients in our study by the end of 1 year after reconstruction is similar regardless of the reconstruction method. Given the minimal invasion during profundoplasty, this operation may be the method of choice for diffuse lesions of the arteries of the lower extremities.

scholarly journals Comparative results of isolated profundoplasty and distal bypass surgery in patients with diabetes mellitus and trophic ulcers

2020 ◽  
Vol 27 (2) ◽  
pp. 38-48
Author(s):  
L. A. Bokeria ◽  
V. S. Arakelyan ◽  
V. G. Papitashvili ◽  
S. Sh. Tzurtzumia
Keyword(s):  
Postoperative Period ◽  
Lower Limb ◽  
Bypass Surgery ◽  
Lower Leg ◽  
Early Postoperative Period ◽  
Transcutaneous Oxygen ◽  
Target Values ◽  
Group 2 ◽  
Comparative Results ◽  
Group 1

Aim. To compare the results of lower limb revascularization in patients with diffuse lesions of lower limb arteries who underwent femoral-distal bypass surgery and isolated reconstruction of the deep femoral artery (DFA) in the immediate postoperative period.Materials and methods. The study included 86 patients with diffuse arterial lesions of lower extremities, 52 (60.4%) men and 34 (39.6%) women with the average age of 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the Poupart’s ligament; the condition of the lower leg arteries was 5–8.5 points on the Rutherford scale. Trophic ulcers were present in all cases. Group 1 included 48 patients who underwent reconstruction of lower leg arteries. Group 2 included 38 patients whose surgical intervention was limited to endarterectomy from the common femoral and deep femoral arteries.Results. In the early postoperative period, 1 (2.1%) patient (from group 1) died from developed myocardial infarction. The patient underwent a femoral-popliteal-tibial bypass surgery with a composite Y-shaped graft. In group 2, no fatal complications were observed. After the operation, all patients demonstrated an increase in the linear blood flow velocity in the arteries of the foot and the transcutaneous oxygen tension (TOT). The TOT level 14 days after surgery comprised 44.1 mm Hg and 39.9 mm Hg (p> 0.05) in groups 1 and 2, respectively.Conclusions. In 86.8% of patients, isolated profundoplasty followed by vasotropic therapy allows the target values of TOT to be obtained, which is necessary for successful healing of lower limb trophic ulcers.

scholarly journals Comparative results of different methods of arterial reconstruction in the patients with critical stenosis of the femoral-popliteal-tibial segment

2017 ◽  
Vol 16 (3) ◽  
pp. 41-48 ◽  
Author(s):  
A. A. Koidan ◽  
I. V. Batalin ◽  
V. N. Vavilov ◽  
M. Y. Kaputin ◽  
A. V. Atmadzas ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Lower Limb ◽  
Intervention Group ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Tissue Loss ◽  
Long Term Results ◽  
City Hospital ◽  
Research Institute

Introduction. Critical limb ischemia (CLI), which arises from atherosclerotic lesions of the arteries is quite often presently. This problem is actively discussed all over the world. In addition to the disability of the patients due to limb loss, the death rate from this disease is comparable to mortality from malignant tumors. Objective. Evaluate immediate and long-term results and optimize treatment tactics for patients with critical limb ischemia in multilevel lesions of lower limb arteries. Materials and methods. The examination and treatment of patients with CLI was carried out in the Research Institute of Surgery and Urgent Medicine of the First State Medical University of Saint-Petersburg named by I. P. Pavlov, as well as on the basis of the City Clinical Hospital «City Hospital No. 14» and St. Petersburg Research Institute of Emergency Care named by I. I. Dzhanelidze in the period from 2005 to 2016. The study is conducted in patients with atherosclerotic lesion of the main arteries of the lower extremities, which manifests itself as pain at rest and/or tissue loss (stage 3-4 of chronic arterial insufficiency of the limb according to Fontein-Pokrovsky classification). Results. Clinical success of all kinds of interventions was achieved in 166 (88.8 %) patients. However, the negative results were greater in the group where only angioplasty of the lower limb arteries was performed. Long-term results could be traced in 108 (57.8 %) patients for 6 months - 5 years. If we consider all groups as a whole, then the aggravation of ischemia occurred in endovascular intervention group in 62 % of patients, in the group of bypass operations - in 19.61 %, and in the group of hybrid interventions - in 17.65 %. Conclusion. Hybrid methods of treatment are the method of choice for patients with stage 4 ischemia of the lower limb with multilevel lesions of lower extremity arteries. Open surgery on the arteries of the lower extremities remains a very effective method of treating patients with critical ischemia. In turn, the use of endovascular methods is advisable in patients with severe concomitant pathology.

Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique

Injury ◽  
2021 ◽  
Author(s):  
Gonzalo Luengo-Alonso ◽  
Ismael Auñon Martin ◽  
Victor Rodriguez Vega ◽  
Aranzazu Capel Agundez ◽  
Pedro Caba Doussoux
Keyword(s):  
Lower Limb ◽  
Bone Defects ◽  
Long Term Results ◽  
Masquelet Technique

scholarly journals Effective use of various minimally invasive technologies eliminating vertical reflux in the treatment of chronic diseases of the lower limb veins

2020 ◽  
Vol 73 (2) ◽  
pp. 329-331
Author(s):  
Serhiy I. Savolyuk ◽  
Valentyn A. Khodos ◽  
Roman A. Herashchenko ◽  
Vladyslav S. Horbovets
Keyword(s):  
Lower Limb ◽  
High Frequency ◽  
Long Term Results ◽  
Laser Coagulation ◽  
Results Of Treatment ◽  
Functional Classes ◽  
Group 3 ◽  
Group 2 ◽  
Effective Use

The aim: To analyze and evaluate the efficacy of CDLLV treatment, using high-frequency endovascular welding (EVW), endovenous laser coagulation (EVLC) and catheter microfoam echosclerotherapy. Materials and methods: We have treated 329 patients with CDLLV C2-C6 functional classes according to the Clinical Etiological Anatomical Pathophysiology. Of these, 102 patients had vertical reflux eliminated by EVW, in 112 – by EVLC, and in 115 – by catheter microfoam echosclerotherapy. Results: In the EVW group 3 patients (2.94%) had a partial recanalization of coagulated veins 3 months after the procedure. In EVLC group 2 patients (1.79%) also had partial recanalization group after 6 months. In the group of catheter microfoam echosclerotherapy partial recanalization occurred in 3 patients during 3 months of observation, in the period of 6 months – in 2, in the period of 12 months – in 9, in total – in 14 patients (12.17%). The EVW and EVLC methods showed high efficacy of vertical reflux elimination on the great and small subcutaneous veins (GSV/SSV) in CDLLV and have no fundamental differences in the immediate and long-term results of treatment. Microfoam catheter echosclerotherapy leads to a greater number of recanalisations, compared with EVW and EVLC. Conclusions: High-frequency endovenous welding results in complete fibrotic GSV/SSV transformation in 97.06% of patients. Endovascular laser coagulation results in complete fibrotic GSV/SSV transformation in 98.21% of patients. Elimination of vertical reflux by microfoam echosclerotherapy results in complete fibrotic GSV/SSV transformation in 87.83% of patients.

Long-term results of thigh arteriovenous dialysis grafts

2018 ◽  
Vol 20 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Denise Kim ◽  
Cynthia Bhola ◽  
Naomi Eisenberg ◽  
Janice Montbriand ◽  
George Oreopoulos ◽  
...  
Keyword(s):  
Standard Error ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Upper Extremities ◽  
Long Term Results ◽  
High Infection Rate ◽  
Cumulative Proportion ◽  
High Infection ◽  
Arteriovenous Access

Introduction: A proportion of hemodialysis patients exhaust all options for arteriovenous access in upper extremities. Arteriovenous thigh grafts are a potential vascular access option in such patients. Methods: We performed a retrospective study of all thigh arteriovenous access grafts placed between 1995 and 2015. The clinical, demographic patient information and patency of each thigh graft was determined from the time of surgical creation placement until abandonment, transfer to other modality, or center or end of study, and the reason for access failure documented. Results: In total, 44 patients received 49 thigh arteriovenous accesses. The average age was 60 years (13–79 years); Half (53%) of the patients (n = 24) were female and 61% of the patients (n = 30) of arteriovenous accesses were left-sided. The cumulative proportion surviving (primary patency rates) at 12, 24, and 28 months were 43% (standard error = 9%), 33% (standard error = 9%), and 13% (standard error = 9%), respectively. The cumulative proportion of surviving grafts at 12, 24, and 48 months were 61% (standard error = 8%), 58% (standard error = 9%), and 31% (standard error = 13%), respectively. In total, 37 revisions were performed in 22 patients to maintain patency or eradicate infection. Infection occurred in 20 patients (39%) of thigh grafts requiring 16 patients (80% of those affected) to be removed; 14 patients had grafts (33.3%) that served as the lone hemodialysis arteriovenous access during the patients’ lifetime on dialysis. Conclusion: Arteriovenous thigh graft access is used infrequently, but they have an acceptable patency. Some accesses require revisions and they have a high infection rate. Despite this, an acceptable proportion of leg grafts provide durable access for the dialysis lifetime of the patient.

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

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.

scholarly journals The poor long-term outcomes of owl’s eye pulmonary reconstruction technique after arterial switch operation

2020 ◽  
Vol 31 (1) ◽  
pp. 113-120
Author(s):  
Mehmet Dedemoğlu ◽  
Oktay Korun ◽  
Gültekin Coşkun ◽  
Fatih Özdemir ◽  
Okan Yurdakök ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Long Term Outcomes ◽  
Arterial Switch ◽  
Switch Operation ◽  
Significant Difference ◽  
Autologous Pericardial Patch ◽  
Group 1

Abstract OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl’s eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl’s eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl’s eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl’s eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate–severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl’s eye reconstruction was the only factor independently related to moderate–severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl’s eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.

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