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

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.

Author(s):  
V.Y. Smorzhevsky ◽  
I.S. Pizhovskyi ◽  
P.A. Gindich

Cardiovascular diseases occupy one of the main groups in the structure of morbidity in most countries. A significant part of this group is affected by the main arteries of the lower extremities. Atherosclerotic diseases of the terminal aorta are combined with stenotic-occlusive lesions of the iliac-femoral, femoral-popliteal and popliteal-tibial arterial segments. Timely diagnosis and choice of treatment to maintain a full life remains one of the most pressing medical problems today. Comprehensive drug therapy used in the treatment of this pathology is ineffective and leads to limb loss, which leads to limited mobility, ability to self-care, contributes to social maladaptation and requires the involvement of the working population to care for the patient. All of the above has led to an expansion of readings to restorative operations aimed at preserving the limbs. However, reconstructive surgery of stenotic-occlusive diseases of the arteries of the lower extremities today is a complex and far from unresolved problem, which contributes to the development of new research to select the optimal method of surgical treatment. The article presents data on hybrid surgical interventions (open surgery and stenting) in 59 patients with chronic ischemia of the lower extremities. The early postoperative period in 4 (6.8%) patients was complicated by hematoma and in 5 patients (8.5%) by postoperative wound lymphorrhea. Hybrid surgeries, in chronic lower extremity ischemia in patients with multilevel lesions of the main arteries, are effective and minimally invasive, especially in patients at high risk of complications. Such technologies allow to save the limb and life of the patient with the minimum trauma, to reduce duration of stay in a hospital.


2011 ◽  
Vol 18 (4) ◽  
pp. 3-10
Author(s):  
A V Krut'ko ◽  
Shamil' Al'firovich Akhmet'yanov ◽  
D M Kozlov ◽  
A V Peleganchuk ◽  
A V Bulatov ◽  
...  

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.


2021 ◽  
pp. 43-47
Author(s):  
Marine Georgiyants ◽  
Olexii Popsuishapka ◽  
Victor Ryndenko ◽  
Sergiy Kursov ◽  
Volodymyr Babalian ◽  
...  

The relevance of the topic is due to the prevalence of lower limbs injuries in people of working age, the complexity of the methods of their surgical treatment and the problem of finding the optimal method of anesthesia in terms of efficiency and safety. Objective of the study: to conduct a systematic analysis of modern scientific literature data on the possibility of using anesthesia methods during surgical interventions and in the case of anesthesia for injuries of the lower limbs in people of working age. Materials and methods. A search for scientific sources was carried out in the scientometric databases Scopus and Web of Science, Google Scholar, archives of journals using the keywords "general anesthesia", "regional anesthesia", "injuries of the lower limbs", "young people", "general anesthesia". The search depth was 8 years. Conclusions. The problem of choosing the method of anesthesia during traumatological surgeries in people of working age has no final solution. In general, both general and regional anesthesia can be used, despite their advantages and the possibility of complications in each case. However, in clinical practice over the past decade, general anesthesia is not always the best method of pain relief. But regional methods have less effect on the vital functions of the body, and the use of ultrasound navigation and modern local anesthetics in a minimum sufficient amount makes anesthesia conduction more effective and safe. The disadvantages of regional anesthesia can be avoided by combining it with general anesthesia. However, in the available literature, there are no recommendations on the differentiated choice of the method of anesthesia for surgical interventions on the lower limbs in people of working age and the factors that influence this


2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.


2021 ◽  
Vol 28 (2) ◽  
pp. 21-28
Author(s):  
Gurgen A. Kesyan ◽  
Grigoriy S. Karapetyan ◽  
Artem A. Shuyskiy ◽  
Rashid Z. Urazgil'deev ◽  
Igor' G. Arsen'ev ◽  
...  

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance. AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty. MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months. RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result). CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.


Author(s):  
Nuzova O.B. ◽  
Faizulina R.R.

Treatment of trophic ulcers of lower extremities is one of the most important problems of surgery. The aim of the study is to determine the features of the microbial landscape of trophic ulcers in various methods of local treatment. The results of studies on the microflora of trophic ulcers of lower extremities in 245 patients of the main and control groups were analyzed. In 96 patients with trophic ulcers (the main group), Miliacil and magnetolaser therapy were used locally in the treatment of trophic ulcers. For the treatment of 60 patients of the first control group with trophic ulcers, Miliacil and laser radiation were applied topically. In the second control group (59 patients), only Miliacil was used. In the third control group (30 patients), 1% dioxidine solution was used topically for the first 7–10 days, and then the treatment was followed by applying the sea buckthorn oil. The microbiological studies of the trophic ulcer contents demonstrated that Miliacil in combination with laser radiation and especially in combination with magnetic laser therapy had a more pronounced antimicrobial effect than only miliacil and even more so than the 1% dioxidine solution and sea buckthorn oil. It was found that in 161 (65.7%) patients the pathogens were inoculated in the form of a monoculture and in 84 (34.3%) - in the form of microbial associations. According to the composition of strains, among monocultures, 67 (41.6%) patients had Staphylococcus aureus, 39 (24.2%) - Proteus, 24 (14.9%) - E. coli, 20 (12.4%) - Pseudomonas aeruginosa and 11 (6.9%) -Streptococcus. The Staphylococcal associations were predominant, they were found in 68 (80.9%) patients. 336 strains of microorganisms were isolated and 296 (88%) of them were resistant to three or more antibiotics. At the end of treatment, in 87 (90.6%) patients of the main group, there was not observed any microflora in the ulcer inoculations. At the end of treatment, the ulcer microflora was not observed in 51 (85%) patients in the first control group, in 36 (61%) patients in the second control group, and in seven (23.3%) patients in the third control group. Thus, as result of studies conducted the specific features of the microbial landscape of trophic ulcers with different methods of topical treatment have been established.


Author(s):  
M.I. Popova ◽  
S.A. Stolyarov ◽  
V.A. Badeyan

Introduction. So far, surgical soft tissue infection accounts for more than half of all cases seeking specialized medical attendance, and its treatment is sometimes rather difficult. The purpose of the work is to study the results of carboxy-lymphotropic therapy while treating patients with surgical soft tissue infection of the lower extremities. Materials and Methods. The study enrolled 57 patients with manifestations of surgical soft tissue infection of the lower extremities. Criteria for enrollment: patients aged 18 to 75, lack of decompensation for concomitant somatic diseases, and lack of systemic inflammatory response. Withdrawal criteria: patients with diabetes mellitus, cancer, decompensation for concomitant somatic diseases, immunodeficiency states (HIV infection, primary immunodeficiency), injecting drug use, pregnancy and lactation. All patients were divided into two groups: the main group and the control group. The main group included 29 patients who underwent carboxy-lymphotropic therapy. Patients of the control group (n=28) were treated according to the standard protocol. Patients of both groups were examined identically. The examination included the study of the wound fluid pH, bacteriological examination of the wound fluid with antibiotic sensitivity test, cytological screening and the study of the microcirculation in the affected area with a laser analyzer «LAKK – M». Results. Carboxy-lymphotropic therapy as the main treatment method allowed to reduce the duration of patients’ treatment and to accelerate the phase change in the wound process. It was proven both experimentally and clinically. Conclusion. Carboxy-lymphotropic therapy significantly improves treatment outcomes in patients with surgical soft tissue infection of the lower extremities. For patients with microcirculation disorders in the affected area, the described method should be mandatory. Keywords: surgical infection, soft tissues, carboxytherapy, lymphotropic therapy. До настоящего времени хирургические инфекции мягких тканей остаются той областью хирургии, на которую приходится более половины случаев обращения за специализированной медицинской помощью, а ее лечение представляет порой существенные трудности. Цель работы – изучить результаты применения карбокси-лимфотропной терапии при лечении пациентов с хирургической инфекцией мягких тканей нижних конечностей. Материалы и методы. Обследованы 57 пациентов с проявлениями хирургической инфекции мягких тканей нижних конечностей. Критерии включения в исследование: возраст пациентов от 18 до 75 лет, отсутствие декомпенсации по сопутствующим соматическим заболеваниям, отсутствие системной воспалительной реакции. Критерии исключения: наличие у пациентов сахарного диабета, онкологических заболеваний, декомпенсация по сопутствующим соматическим заболеваниям, иммунодефицитные состояния (ВИЧ-инфекция, первичный иммунодефицит), инъекционная наркомания, период беременности и лактации. Все пациенты были разделены на две группы – основную и контрольную. В основную вошли 29 пациентов, лечение которых осуществлялось с применением карбокси-лимфотропной терапии. Лечение 28 пациентов контрольной группы проводилось по стандартной схеме. Подход к обследованию пациентов обеих групп был одинаковым и включал в себя исследование рН раневого отделяемого, бактериологическое исследование раневого отделяемого с определением чувствительности выделенных микроорганизмов к антибиотикам, цитологическое исследование и исследование микроциркуляции зоны поражения с помощью лазерного анализатора «ЛАКК-М». Результаты. Применение карбокси-лимфотропной терапии в качестве основного метода лечения позволило сократить время пребывания пациентов на лечении, ускорить смену фаз раневого процесса, что было доказано с помощью ряда лабораторных методов, а также клинически. Выводы. Карбокси-лимфотропная терапия достоверно улучшает результаты лечения пациентов с хирургической инфекцией мягких тканей нижних конечностей. Для категории больных с нарушением микроциркуляции в зоне поражения данный способ должен являться методом выбора. Ключевые слова: хирургическая инфекция, мягкие ткани, карбокситерапия, лимфотропная терапия.


2021 ◽  
pp. 66-71
Author(s):  
Valentin Sergeevich Rzhevsky

The article presents the results of treatment of patients with acute inflammatory diseases of the maxillofacial region using non-drug methods of treatment. Study material: 60 patients with acute purulent-inflammatory diseases of the maxillofacial region (phlegmons and abscesses), who were divided into 2 groups: the main group — 30 patients who underwent a course of complex application of broadband electromagnetic therapy and low — frequency alternating electrostatic field and the control group — 30 patients who were treated with drug therapy (antibiotics, metronidazole group drugs, antihistamines, multivitamins, detoxification therapy, local treatment of the wound process), which served as the background in the main group. Objective: to develop and scientifically substantiate the complex application of broadband electromagnetic therapy and low-frequency alternating electrostatic field in patients with inflammatory diseases of the maxillofacial region. Results. In a comparative aspect, the dynamics of the indicators of the leukocyte intoxication index (LII) and the main indicators of the morphological picture of the blood before and after treatment in patients with HIA CHLO under the influence of the developed complex was studied. Conclusion. The developed complex, which includes a low-frequency alternating electrostatic field and broadband electromagnetic therapy, contributes to the formation of pronounced anti-inflammatory and detoxifying effects in patients with inflammatory diseases of the maxillofacial region due to a significant reduction in endogenous intoxication, which allows us to recommend it for inclusion in complex therapeutic and rehabilitation programs after surgical interventions to accelerate the time of purulent wound cleansing and reduce the length of hospital stay.


2016 ◽  
Vol 22 (2) ◽  
pp. 201621
Author(s):  
Ivanna Koshel

Surgical interventions in the nasal cavity are accompanied by reactive phenomena in the postoperative period. On their background the process of physiological regeneration is disorganized resulting in impaired physiological functions of the nasal cavity.The objective of the research was to study the recovery process of the main physiological functions of the nasal cavity in patients with aspirin-intolerant polypous rhinosinusitis in the postoperative period.Materials and methods. 80 patients with aspirin-intolerant polypous rhinosinusitis at the age of 24-57 years were operated on.All the patients were divided into 2 groups: the control group included 30 patients; the main group comprised 50 patients.Patients of the control group received nasal cavity cleaning, nasal mucosa anemisation, irrigation therapy since the first day of the postoperative period.Patients of the main group received an herbal drug BNO-101 additionally. The effectiveness was assessed on the 3rd, 7th and 10th days of treatment.Results. The postoperative rehabilitation with the inclusion of botanical preparation BNO-101 provided a significant improvement of nasal breathing, mucociliary transport rate and indicators of nasal peak flowmetry compared to the control group. Despite subjective improvement of nasal breathing the indicators of the peak expiratory flow rate in the main group were 34.2% lower than the norm while in the control group they were 54.7% lower than normal ones thereby justifying further treatment.Conclusions. The postoperative rehabilitation of patients with aspirin-intolerant polypous rhinosinusitis provided more rapid improvement of the main functions of the nasal cavity compared to the control group.


2021 ◽  
Vol 20 (2) ◽  
pp. 38-44
Author(s):  
V.A. Yanushko ◽  
◽  
I.P. Klimchuk ◽  
S.V. Mshar ◽  
G.E. Kordzakhia ◽  
...  

Objectives. To analyze short-term results of endovascular treatment for obliterating atherosclerosis of the lower extremities arteries in patients over 70 years of age. Material and methods. From 2015 to 2019, 75 lower limbs were revascularized in 72 patients. Their mean age was 74.7±4.51 years. There were 67 (93%) patients with ischemia of the 3rd - the 4th degree according to Fontaine-Pokrovsky classification. Revascularization of the iliac segment was performed in 35 (48.6%) patients, of the iliofemoral segment - in 5 (7%), the femoral-popliteal segment - in 24 (33.4%), the tibial segment - in 8 (11%) patients. Results. Technical success was attained in 97.2% of cases. The limb preservation was achieved in 100% of cases. Thrombosis of the revascularized artery developed in 2 (2.7%) cases (it was repaired endovascularly). Two patients (2.77%) died of acute cardiac failure. Conclusions. Our study has shown good early results of endovascular treatment for obliterating atherosclerosis of the lower limbs arteries in patients over 70 years of age. High amputations were avoided in 100% of cases. However, an assessment of long-term results is required.


Sign in / Sign up

Export Citation Format

Share Document