scholarly journals Comparative analysis of the surgical treatment results in patients, suffering obliterating atherosclerosis of the lower extremities arteries with multi–level occlusion–stenotic affection on background of critical ischemia

2018 ◽  
Vol 85 (7) ◽  
pp. 34-38
Author(s):  
А. М. Bytsai
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Lower Extremities ◽  
Primary Angioplasty ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Type D ◽  
Multi Level ◽  
Peripheral Arterial ◽  
Operation Results

Objective. To improve the results of surgical treatment in patients, suffering obliterating atherosclerosis of the lower extremities (LE) arteries with a multi-level occlusive affection, occurring on background of critical ischemia (CІ). Маterials and methods. The results of surgical treatment of 93 patients, suffering a multi-level occlusive affection of the LE arteries, occurring on background of CІ, performed with obligatory ultradistal restoration of the blood circulation, were analyzed. The main group consisted of 47 (51%) patients, to whom a hemi-open endarterectomy from popliteal artery was performed together with a popliteo-foot autovenous shunting, and a comparison group, consisting of 46 (49%) patients, in whom endovascular angioplasty of popliteo-tibial segment was done. Results. Comparative analysis of the surgical interventions performed have witnessed, that while presence of the Types С and D occlusive-stenotic affections in accordance to classification of Тransatlantic Consensus (TASC II), a choice for open reconstructions must be prioritized, and in a Type В and in some of a Type С observations – a primary angioplasty. When the Type С peculiarities of occlusive affection were revealed, a differentiated approach must be applied while formulating indications for the operation. Results of the interventions performed were followed-up in late period (up to 24 mo). Conclusion. While diagnosis of a Type D occlusion of the shin segment a priority must be referred to operation of a popliteo-foot shunting, and in a Type С – to primary angioplasty, only in presence of diffuse stenotic process without «free» аrterial segment of the foot. Administration of vasostenone promotes effective reduction of peripheral arterial resistance in patients after performance of open surgical intervention as well as in those after angioplasty operation.

scholarly journals THE HYBRID SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF LOWER EXTREMITIES

2017 ◽  
Vol 23 (5) ◽  
pp. 233-236 ◽  
Author(s):  
M. B Temrezov ◽  
Vladimir I. Kovalenko ◽  
R. S Bulgarov ◽  
A. S Bakhmetev ◽  
T. Kh Temrezov ◽  
...  
Keyword(s):  
Clinical Success ◽  
Lower Extremities ◽  
Primary Patency ◽  
Direct Access ◽  
Secondary Patency ◽  
Critical Ischemia ◽  
Severe Condition ◽  
Iliac Arteries ◽  
Surgical Interventions ◽  
Multi Level

The purpose of study is to evaluate efficiency of hybrid surgical interventions under critical anemia of lower extremities in patients with multi-level atherosclerosis affection of arterial bed.The material and methods. The results of surgical treatment using hybrid technology are analyzed. The sampling consisted of 38 patients (33 males and 5 females) suffering from critical anemia of lower extremities because of multi-level atherosclerosis affection of main arteries. The average age was 69,6±2,5 years. The 21 patients (group 1) underwent balloon angioplasty with stenting of iliac arteries through direct access in femoral artery using balloon enlarging stents Asssurant and at the same time instant femoral popliteal stenting. The 17 patients (group 2) underwent stenting of iliac arteries combined with endarterectomy from common and deep arteries of thigh with profundoplastics.The results. The immediate and distant results of treatment in both groups had no differences. After endovascular interventions at iliac segment a primary technical success was achieved in 92.1% of cases and a clinical success - at 81.1% of cases. In the zone of open vascular interventions in femoral popliteal segment primary and secondary patency made up to 89.5% and 97.4% correspondingly. The rate of keeping of extremity in general made up to 92.1% and lethality - 7.9%. The distant results up to three years were monitored in 35 patients. The primary patency in the zone of endovascular intervention after 1, 2 and 3 years made up to 89,8, 76,2 and 68,5% correspondingly. In 5 patients (13.2%) repeated operations were implemented. The level of keeping of extremity after 1,2 and 3 years made up to 77.4%, 74.1% и 72.5%. The survival after 1,2 and 3 years made up to 94,3%, 88,6% and 85,7% correspondingly.The conclusion. The hybrid interventions (stenting of iliac arteries combined with surgical adjustment of femoral popliteal segment) under critical ischemia of lower extremities in the first place are effective and expedient for patients in severe condition and high surgical risk.

ENDOVASCULAR AND OPEN SURGICAL OPERATIONS OF CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

Vestnik ◽  
2021 ◽  
pp. 304-312
Author(s):  
Д.Д. Поцелуев ◽  
С.Е. Турсынбаев ◽  
Р.А. Сапарбаев ◽  
Е.А. Асылбеков ◽  
С.А. Илиев ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Comparative Analysis ◽  
Vascular Surgery ◽  
Lower Extremities ◽  
Clinical Results ◽  
Main Section ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Surgical Operations

В отделении сосудистой хирургии на протяжении 40 лет (с 1972 по 2012 гг.) было выполнено 9800 открытых операций у больных с КИНК II-IIIст, клинические результаты которых представлены в соответствующем разделе статьи для сравнительного анализа. В основном разделе работы рассматриваются результаты эндоваскулярных хирургических и открытых операций, выполненных у 1088 больных с критической ишемией нижних конечностей II-IIIст (КИНК) и сахарным диабетом (СД). Проведен сравнительный анализ показателей частоты ампутаций при открытых и эндоваскулярных хирургических вмешательствах (ЭХВ). Установлено преимущество ЭХВ в сравнении с открытыми операциями на основании снижения числа ампутаций после выполненных ЭХВ соотвественно с 52,3% до 3,5%. In the department of vascular surgery, for 40 years (from 1972 to 2012), 9800 open operations were performed in patients with CLI II-IIIst, the clinical results of which are presented in the corresponding section of the article for comparative analysis. The main section of the work examines the results of endovascular surgical and open operations performed in 1088 patients with critical ischemia of the lower extremities II-IIIst (CLI) and diabetes mellitus (DM). A comparative analysis of indicators of the frequency of amputations during open and endovascular surgical interventions (ECS) was carried out. The advantage of ECV in comparison with open operations was established on the basis of a decrease in the number of amputations after ECV performed, from 52.3% to 3.5%, respectively.

scholarly journals Improvement of surgical treatment of patients with critical ischemia of the lower extremities

2017 ◽  
Vol 4 (2) ◽  
pp. 455
Author(s):  
Shavkat Karimov ◽  
Akmal Irnazarov ◽  
Uktamkhon Askarovich Asrarov ◽  
Ulugbek Alijanov ◽  
Abdurasul Yulbarisov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Endarterectomy ◽  
Clinical Manifestations ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Critical Ischemia ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Associated Lesions ◽  
Reconstructive Operations

Background: The choice of tactics of surgical treatment in patients with lesions of the femoral-popliteal-tibial segment with the CILE is the actual problem, which is far from being solved. Aim of the study was to found improved treatment of patients with critical ischemia of the lower extremities by improving the surgical approach.Methods: 79 patients with critical ischemia of the lower extremities with lesions of the carotid and coronary arteries were observed and surveyed. To determine the tactics of treatment of these patients, we used non-invasive methods of imaging vessels, and only with probable therapeutic purposes used the contrasting of the vessels.Results: The used treatment allowed reducing the number of complications to a minimum. Among observable patients, in one case was determined acute myocardial infarction. 19 (24%) patients with stenosis and CILE managed to achieve regress of clinical manifestations of lower limb ischemia with medical therapy. In 12 (63.1%) patients were completed the installation of long catheter for intra-arterial catheter therapy, after that we performed carotid endarterectomy. Of these, 9 (47.3%) patients at 7 days underwent reconstructive operations on arteries of the lower extremities. In 5 (26.3%) patients after carotid endarterectomy, endovascular interventions implemented at ALE.Conclusions: The suggested diagnostic low and stages of surgical interventions significantly increase the detection of associated lesions of other arterial basins and expands the indications for surgical treatment with the use of combined interventions.

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.

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.

scholarly journals Surgical treatment of stenotic–occlusive affections of the lower extremity arteries in patients, suffering ischemic form of the diabetic foot syndrome

2018 ◽  
Vol 85 (7) ◽  
pp. 39-42
Author(s):  
S. М. Didenko
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Type Ii ◽  
Arterial Reconstruction ◽  
Arterial Segment ◽  
Critical Ischemia ◽  
Diabetes Mellitus Type Ii ◽  
Femoral Reconstruction

Objective. To compare the efficacy of different methods of surgical treatment for stenotic-occlusive affection of the lower extremities (LE) arteries in patients with ischemic form (ІF) of diabetic foot syndrome (DFS). Маterials and methods. Results of surgical treatment were analyzed in 164 patients, suffering diabetes mellitus Type II, complicated by IF of DFS with critical ischemia on background of combined stenotic-occlusive affection of the femoral and popliteo-tibial segments arteries. Results. Primary passability of the femoral reconstruction zone was registerd in 65.6% of patients, in whom reconstruction of femoral arterial segment was performed without intervention on arteries of popliteo-tibial segment, and the secondary one – in 81.9%, high amputations rate have constituted 18% and lethality – 11.5%. Primary passability of the femoral reconstruction zone was registered in 89.5% patients, to whom a two-level reconstruction of femoral and popliteo-tibial arterial segments was performed, and a secondary one – in 92.1%, high amputations rate have constituted 5.2% and lethality – 7.9%. Primary passability of the femoral reconstruction zone was registered in 81.5% patients, to whom hybrid arterial reconstruction was performed, and a secondary one – in 93.9%, high amputations rate have constituted 7.7% and lethality – 4.6%. Conclusion While coexistence of the superficial femoral artery (SFA) occlusion with stenotic-occlusive affection of the popliteo-tibial segment arteries in patients, suffering stenotic-occlusive affection of arteries in popliteo-tibial segment in cases with IF of DFS the results of performance of isolated operation for the SFA restoration were the worst. The results of a two-level and a hybrid operations may be considered comparable. Primary passability of the arterial reconstruction zone in patients, to whom a two-level reconstruction was performed, is highest, but lethality almost twice as bigger, than after hybrid arterial reconstruction. Hybrid reconstructive operation constitutes optimal procedure in patients, suffering lower extremities (LE) arteries affection in cases with the ІF of DFS, combined with stenotic-occlusive affection of arteries in femoral and popliteo-tibial segments.

scholarly journals The use of rotational thrombectomy in the treatment of arterial thrombosis

2018 ◽  
Vol 22 (3) ◽  
pp. 464-467
Author(s):  
V.V. Petrushenko ◽  
Ya.V. Khrebtii ◽  
O.M. Skupyi ◽  
O.I. Mitiuk ◽  
S.A. Cheshenchuk
Keyword(s):  
Lupus Erythematosus ◽  
Arterial Thrombosis ◽  
Clinical Signs ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Modern Method ◽  
Acute Onset ◽  
Critical Ischemia ◽  
Rotational Thrombectomy ◽  
Peripheral Arterial

Rotation thrombectomy is a modern method of treating peripheral arterial disease. To date, there are no randomized studies regarding rotational thrombectomy. We want to share our own results in the treatment of patients with arterial thrombosis in the treatment of 8 patients with arteriosclerosis of the lower extremities, complicated by thrombosis using Rotarex. Patients noted the acute onset of the disease, but were referred to the clinic after 2 weeks since the onset of clinical signs of the disease. All patients underwent ultrasound examination, arteriography of the affected arterial segment. After treatment, all patients underwent control angiography. During the procedure, heparin and clopidogrel were administered. One patient had systemic lupus erythematosus. Patients had thrombosis of the femoro-popliteal arterial segments. All patients had a critical ischemia of the lower extremities. Men were 6, women — 2. 2 (25%) of patients had thrombosis of the stent of the superficial femoral artery. In 8 (100%) cases, rotational thrombectomy with rotary catheter was used. For the procedure, catheters with a diameter of 6F and a length of 110–135 cm were used. During the procedure, a catheter was performed from 3 to 5 passages in the affected segment. Duration of the procedure was 1.5–2 hours. In 6 (75%) cases, after the thrombectomy, ballooning of the affected segment was used with a balloon covered with polytaxel. In 8 (100%) patients, there was a clinical improvement. In 8 (100%) patients, control arteriography showed complete patency of the affected segments of the femoral and popliteal arteries. In 8 patients, ischemia was regressed. Cases of rethrombosis were not observed. Thus, rotation thrombectomy is a modern and effective method of treatment of arterial thrombosis of the femoral and popliteal segment.

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.

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