scholarly journals REMOTE 3-YEAR RESULTS OF APPLICATION OF «INDIRECT» WAYS OF REVASCULARIZATION IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER EXTREMITIES

2015 ◽  
Vol 174 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Yu. V. Chervyakov ◽  
I. N. Staroverov ◽  
A. V. Borisov ◽  
E. G. Nersesyan ◽  
O. N. Vlasenko ◽  
...  
Keyword(s):  
Conservative Therapy ◽  
Lower Extremities ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Lumbar Sympathectomy ◽  
Indirect Revascularization ◽  
The Difference ◽  
Positive Results ◽  
Efficacy Of Treatment

There are several ways of «indirect» revascularization such as revascularizated osteotrepanation of shinbone and lumbar sympathectomy (LS) for treatment of patients with chronic ischemia of lower extremities. They appeared to be sufficiently effective for the patients with II stage of the disease. Patients with critical ischemia (III stage) had persistent positive results after lumbar sympathectomy during 3-year period only in 33% of cases and using revacularized osteotrepnation - 46%. The difference in efficacy of treatment using LS and standard conservative therapy is statistically low significant, so that isn’t allowed recommending the sympathectomy for treatment of III stage ischemia. The method of revascularizated osteotrepanation of shinbone showed a reliably better result, therefore this way is reasonable to apply in surgery in case of III stage ischemia.

scholarly journals Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

2021 ◽  
Vol 88 (3-4) ◽  
pp. 21-27
Author(s):  
Yu. V. Ivanova ◽  
I. A. Kryvoruchko ◽  
V. A. Prasol ◽  
K. V. Miasoiedov ◽  
S. A. Andreieshchev
Keyword(s):  
Diabetes Mellitus ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Critical Ischemia ◽  
Diabetes Mellitus Type Ii ◽  
Indirect Revascularization ◽  
Autologous Mesenchymal Stem Cells

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix. Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted. Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

scholarly journals Possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremiti

2020 ◽  
Vol 87 (3-4) ◽  
pp. 59-64
Author(s):  
J. V. Kosayev ◽  
I. A. Hasanov ◽  
N. S. Abushov ◽  
G. T. Tagizade ◽  
I. L. Namazov
Keyword(s):  
Laser Irradiation ◽  
Cellular Immunity ◽  
Standard Treatment ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Arterial Stenosis ◽  
Critical Ischemia ◽  
Joint Application ◽  
Group I ◽  
Indirect Revascularization

Objective. To study up the possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremities. Materials and methods. Prospective controlled clinic-laboratory investigation was performed in 162 patients, suffering critical ischemia of the lower extremities on background of distal arterial stenosis (occlusion) and to whom indirect revascularization operations were done. Etiology of the lower extremities critical ischemia were the obliterating atherosclerosis - in 108 (66.7%) patients and obliterating thrombangiitis - in 54 (33.3%) patients. In 56 patients a Degree III was diagnosed, and in 106 patients - IV Degree of chronic ischemia. In perioperative period in 34 patients a standard treatment was performed (Group I), in 32 patients - standard treatment and intravenous laser irradiation of the blood (Group II), in 32 patients - standard treatment and cytokinotherapy with roncolekin (Group III), in 33 patients - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group IV), in 31 patients in a revascularized osteotrepanation with intramedullary laser irradiation - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group V). Parameters of cellular immunity (CD3+, CD4+, CD8+lymphocytes; ratio CD4+/CD8+) and of phagocytosis were studied in dynamics. The cellular immunity indices were compared with identical indices in 48 practically healthy persons (a reference group). Results. While admittance to hospital in patients with critical ischemia of the lower extremities in a distal stenosis (occlusion) the abrupt change of cellular immunity was revealed towards the immune insufficiency. Inclusion of intravenous laser irradiation of the blood and of cytokinotherapy, separately or in combination, into the treatment measures complex of perioperative period in indirect revascularization have leaded towards trustworthy (p < 0.05) elimination of the cellular immunity indices. Correction of cellular immunity trustworthily depended on (p < 0.01-0.001) the treatment factor with moderate (r =0.5- 0.6) correlation. Best results were obtained while joint application of intravenous laser irradiation of the blood and cytokinotherapy in perioperative period in indirect revascularizaation, peculiarly while operation of revascularized osteotrepanation with intramedullary laser irradiation. Conclusion. Application of intravenous laser irradiation of the blood and cytokinotherapy together with standard treatment in perioperative period while doing indirect revascularization corrects the cellular immunity trustworthily in patients, suffering critical arterial ischemia of the lower extremities, and the dynamics of these indices may be used as an objective criterion of the efficacy estimation for the therapy conducted.

Experience of endovascular treatment of patients with chronic ischemia threatening the loss of a limb

2021 ◽  
Vol 88 (2) ◽  
pp. 38-43
Author(s):  
V.Ya. Rudman ◽  
◽  
K.A. Kalashnikov ◽  
G.A. Burov ◽  
◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Extremities ◽  
Limb Loss ◽  
Diabetic Foot Syndrome ◽  
Correct Selection ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Endovascular Revascularization ◽  
Global Trend

The aim of the study was to assess the technical feasibility of endovascular revascularization of the arteries of the lower extremities in the development of critical ischemia of the lower extremities (chronic ischemia with threatening limb loss), including diabetic foot syndrome. Two clinical cases of endovascular revascularization of lower limb arteries with the development of chronic ischemia with threatening limb loss and diabetic foot syndrome were analyzed. Median age was 61 (60–62) years; there was 1 male (50 %). Upon hospitalization, the risk of limb loss according to the WIfI classification was assessed in one case as high, in the other as medium. The efficiency of revascularization was 100 %. In 1 case (50 %), a second intervention was required. High amputation after surgery during the next year of follow-up was 100 % not necessary. The duration of the operation was 120–150 minutes. The survival rate during the year of follow-up after surgery was 100 %. Clinical observation demonstrates that even with the correct selection of patients, stratification of risk factors for both possible loss of a limb and the risk of surgery, as well as the correctness of the chosen tactics for revascularization of the CPR, only with an increase in the number of procedures performed, routing training and the creation of specialized centers is it possible to achieve satisfactory results in treatment of this problem, which, as the global trend shows, will worsen as the incidence of diabetes increases and the population ages

scholarly journals Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

2021 ◽  
Vol 88 (3-4) ◽  
pp. 28-34
Author(s):  
M. M. Lopit ◽  
V. І. Rusyn ◽  
P. A. Boldizhar ◽  
F. V. Gorlenko ◽  
O. M. Kochmar
Keyword(s):  
Surgical Treatment ◽  
Lower Extremities ◽  
Late Results ◽  
Anterior Tibial Artery ◽  
Critical Ischemia ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial ◽  
Indirect Revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice. Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment. Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients. Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients. Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Dynamic Scintigraphy of the Oesophagus in the Evaluation of Reflux Oesophagitis

1990 ◽  
Vol 29 (05) ◽  
pp. 204-209
Author(s):  
B. Ugarković ◽  
D. Ivančević ◽  
D. Babić ◽  
Ž. Babić
Keyword(s):  
Reflux Oesophagitis ◽  
Oesophageal Reflux ◽  
Low Grade ◽  
Time Activity ◽  
The Difference ◽  
Asymptomatic Subjects ◽  
Oesophageal Transit ◽  
Dynamic Scintigraphy ◽  
Positive Results ◽  
Reflux Œsophagitis

A method is presented which combines gastro-oesophageal reflux quantification and oesophageal transit measurement so as to differentiate true reflux from residual oesophageal activity. A group of 33 subjects with gastro-oesophageal reflux symptoms and endoscopically confirmed reflux oesophagitis and a group of 21 asymptomatic subjects with normal oesophageal, gastric and duodenal endoscopic findings were examined. The subjects were given 37 MBq 99mTc-Sn-colloid in saline orally and then scintiscanned dynamically. The gastro-oesophageal quantification was done after transit measurement and after the oesophageal time activity (to detect residual oesophageal activity) reached its minimum. The difference in the reflux indices between the two groups was highly significant. In low-grade oesophagitis measured reflux was lower than in higher grades of disease. Only 4.7% false-positive results were observed with a specificity of 95%, indicating that this method may be superior to methods published earlier.

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).

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