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 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 Results of surgical treatment in patients, suffering diabetes mellitus and chronic critical ischemia of lower extremity, taking into account the data of intraoperative debitometry

2020 ◽  
Vol 87 (5-6) ◽  
pp. 36-40
Author(s):  
S. M. Didenko ◽  
Yu. M. Hupalo ◽  
V. Yu. Subbotin ◽  
A. M. Kutsyn ◽  
A. A. Jaghdal
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Lower Extremity ◽  
Popliteal Artery ◽  
Arterial Reconstruction ◽  
Arterial Segment ◽  
Critical Ischemia ◽  
Group Iii ◽  
Tibial Arteries ◽  
Group I

Objective. To analyze the results of surgical treatment of patients, suffering diabetes mellitus, ischemic form of diabetic foot syndrome and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial and popliteo-tibial segments, taking into account the data of intraoperative debitometry. Materials and metods. Results of surgical treatment were analyzed in 67 patients, suffering diabetes mellitus Type II, ischemic form of diabetic foot syndrome and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial and popliteo-tibial segments in 1 and 12 mo. In all the patients a femoro-popliteal shunting without intervention on the popliteo-tibial segment was performed. In accordance to the results obtained during intraoperative debitometry, the patients were distributed into three Groups: Group I - 22 patients with the shunt debit more than 60 ml/min, Group II - 25 patients with the shunt debit 30-60 ml/min, and Group III - 20 patients with the shunt debit lesser than 30 ml/min. In thrombosis of primary zone of arterial reconstruction a reoperation was conducted - a hybrid arterial reconstruction of the popliteo-tibial (thrombectomy from shunt and the balloon angioplasty) segment arteries. Results. In a Group I (n=22) a primary passability of the arterial reconstruction zone in 1mo was observed in 20 (90.9%), and in 12 mo - in 17 (77.3%) patients; in Group II (n=25) - accordingly, in 19 (76%) and 14 (56%) patients; in Group III (n=20) - accordingly, in 9 (45%) and 4 (20%). Thronbosis in the arterial reconstruction zone was diagnosed during a year in 32 patients, of them during first month after primary shunting - in 19 (59.4%), during further 11 mo - in 13 (40.6%) patients. After reoperation for thrombosis of the arterial reconstruction zone, consisting of a hybrid arterial reconstruction, secondary passability of the arterial reconstruction zone during 12 mo was observed in 24 (75%) of 32 patients. While restoration of outflow from popliteal artery into one tibial artery (n=23) during 12 mo a rethrombosis of the arterial reconstructive zone have occurred in 7 patients, secondary passability of the arterial reconstruction zone during 12 mo was observed in 16 (69.6%) patients. While restoration of outflow from popliteal artery into two tibial arteries (n=9) during 12 mo rethrombosis of the arterial reconstruction zone have occurred in 1 patient, secondary passability of the arterial reconstruction zone during 12 mo was observed in 8 (88.9%) patients. Conclusion. In combined stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment the isolated restoration of passability and femoral arterial segment without intervention on arteries of popliteo-tibial segment necessitates taking into account the intraoperative debitometry data with determination of the shunt debit constitutes an effective diagnostic method, the data of which may help to adjust a differentiated approach to tactics of surgical treatment in patients, suffering diabetes mellitus, chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment. The shunt debit bordering value, in presence of which the isolated restoration of the femoral arterial segment passability is possible, constitutes the indices higher than 60 ml/min, further intervention on the popliteo-tibial segment arteries is indicated only in the patients with the shunt thrombosis; while in the shunt debit 30-60 ml/min a reconstruction stage of the popliteo-tibial segment arteries after restoration of the femoral arterial segment passability may be postponed and performed on second stage of the procedure; while the shunt debit lesser than 30 ml/min - a simultaneous reconstruction of femoral segment and of the popliteo-tibial arteries, using performance of a hybrid arterial reconstruction, is necessary. The last is effective method of restoration of blood circulation in patients, suffering diabetes mellitus and chronic critical ischemia of the lower extremity, caused by stenotic-occlusive affection of femoral arterial segment and arteries of popliteo-tibial segment, and in accordance to the results adduced (index of the arterial reconstruction zone passability during 12 mo have constituted 75%) do not differ trustworthily from result of reconstruction of arterial segment in patients of Group I: the shunt debit more than 60 ml/min, while index of the arterial reconstruction zone passability during 12 mo constitutes 77.3% (p>0.05). While thrombosis of primary zone of arterial reconstruction the addition of thrombectomy from the shunt by restoration of the main blood flow from popliteal into two tibial arteries, using the balloon angioplasty, demonstrates a trustworthy best index of secondary passability of the arterial reconstruction zone in 12 mo - 88.9%, comparing with index of secondary passability of the arterial reconstruction zone in 12 mo after restoration of the main blood flow from popliteal artery into one tibial artery - 69.6% (p< 0.05).

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 Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 60-64
Author(s):  
Sergey Y. Ivanusa ◽  
Boris V. Risman ◽  
Andrey V. Yanishevskiy
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diabetic Foot ◽  
Pain Syndrome ◽  
Diabetic Foot Syndrome ◽  
Military Medical Academy ◽  
Results Of Treatment ◽  
Medical Academy ◽  
Invasive Method ◽  
Short Time

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

2021 ◽  
Vol 2 (3(5)) ◽  
pp. 20-29
Author(s):  
S.Ya. Ivanusa ◽  
◽  
B.V. Risman ◽  
A.V. Yanishevsky ◽  
R.E. Shayakhmetov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Diagnostic Algorithm ◽  
Ultrasonic Cavitation ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Physical Methods ◽  
Purulent Wounds

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

Actual cost of complex surgical treatment of patients with neuroischemic form of diabetic foot syndrome

2015 ◽  
pp. 48 ◽  
Author(s):  
◽  
V. A. Mitish ◽  
F. T. Mahkamova ◽  
Ju. S. Pashalova ◽  
V. A. Gruzman ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Actual Cost
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