scholarly journals FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

2021 ◽  
Vol 4 (18) ◽  
pp. 38-44
Author(s):  
S.Y. Kostiv ◽  
I.K. Venger ◽  
B.Y. Maslii ◽  
B.P. Selskyi ◽  
N.I. Tsiupryk ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Arterial Blood Flow ◽  
Arterial Segment ◽  
Arterial Blood ◽  
Tibial Arteries ◽  
Group I ◽  
Hybrid Revascularization ◽  
Stenotic Lesions

                The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment.                 Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction.                 Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries.                 Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

scholarly journals Impact of the Initial Coagulation Parameters and the Time Interval between Hemostatics and Anti coagulants on the Risk of Thrombohemorrhagic Complications After Endoprosthetics of Large Joints

Biomeditsina ◽  
2021 ◽  
Vol 17 (3) ◽  
pp. 34-38
Author(s):  
L. S. Golovko ◽  
A. V. Safronenko ◽  
Yu. S. Maklyakov ◽  
E. V. Gantsgorn ◽  
N. V. Sukhorukova ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Anticoagulant Therapy ◽  
Postoperative Period ◽  
Joint Replacement ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Time Interval ◽  
Male And Female ◽  
Coagulation Parameters ◽  
Female Patients

The article confirms the significance of the time interval of at least 18 hours between the hemostatic and anticoagulant therapy, which is of particular importance when tranexamic acid is used. An analysis of the thrombohemorrhagic complications developed in the early postoperative period after arthroplasty of large joints of the lower extremities was carried out. In addition, the most significant coagulation parameters were determined, whose deviation from the norm before surgery increased the risk of thrombosis and bleeding after joint replacement among male and female patients.

scholarly journals Hybrid approach of arterial allograft application in reconstructive surgery of the great arteries

2021 ◽  
Vol 102 (1) ◽  
pp. 104-109
Author(s):  
R E Kalinin ◽  
I A Suchkov ◽  
V V Karpov ◽  
N A Solianik ◽  
A S Pshennikov ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Blood Circulation ◽  
Hybrid Approach ◽  
Clinical Situation ◽  
Early Postoperative Period ◽  
Patient Treatment ◽  
Tibial Arteries ◽  
Arterial Allograft ◽  
Dacron Prostheses

The article presents a case of a hybrid intervention using an arterial allograft on the great arteries of the lower extremities in a patient with chronic limb threatening ischemia and prosthetic infection. The patient has a history of repeated operations using synthetic polytetrafluoroethylene and dacron prostheses. In the early postoperative period, a clinical presentation of the prosthesis bed suppuration developed. The article shows the main phases of patient treatment: removal of synthetic prostheses, transplantation of the donor femoral artery, and balloon angioplasty of the popliteal and anterolateral arteries. In the postoperative period, blood circulation in the lower limb is fully compensated, and the dorsal pedis artery pulse is determined. Wounds were healed by primary intention. At the control visit after 6 months, no adverse events were revealed; according to the data of duplex scanning, the main blood flow in the arteries of the leg was recorded, the blood circulation was fully compensated. Thus, hybrid intervention using arterial allograft and balloon angioplasty of the popliteal and anterolateral tibial arteries proved to be an effective method of treatment in the current clinical situation.

scholarly journals Management of patients in the post-operative period after the hip joint replacement accessed by low-invasive access

2019 ◽  
Vol 1 (4) ◽  
pp. 32-38
Author(s):  
N S Nikolaev ◽  
A V Efimov ◽  
R V Petrova ◽  
D V Kovalev ◽  
M I Ivanov
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Modified Rankin Scale ◽  
Surgical Access ◽  
Group I ◽  
Group Ii

Up to 1.5 million total hip arthroplasty is performed annually in the world. In Russia, at least 300 thousand patients a year need hip replacement surgery. High tissue invasiveness during surgical approaches presents special requirements for the rehabilitation process in the early postoperative period. Accelerating and making it more efficient is possible with the use of the least traumatic operating access. The purpose of the study is a comparative analysis of two models of the organization of rehabilitation in the postoperative period after hip arthroplasty: using standard Harding surgical access and the minimally invasive Rottinger access. Material of the study - patients operated on with standard Harding access (group I, n = 227) and front-external Rottinger access (group II, n = 266). Criteria for inclusion of patients in both groups are primary coxarthrosis without previous surgical interventions, exclusion criteria are connective tissue diseases, severe comorbidity. Group I patients underwent postoperative rehabilitation according to the standard protocol, group II - according to the rehabilitation concept "ERAS, fast-track". To assess the effectiveness of the rehabilitation at all stages in both groups, the rehabilitation potential was assessed on the rehabilitation routing scale (SRM), the dynamics of the pain syndrome on the visual analogue pain scale (VAS), the verticalization period was taken into account, the main assessment scales of the patient's motor functions and psychological status were used in hip arthroplasty: Harris scale, quality of life questionnaire (EQ - 5D), modified Rankin scale. Results and discussion. The proportion of hip arthroplasty using MIS access in the total number of operations increased from 0.7% in 2015 to 10.1% in 2018. The studied groups are comparable in terms of the ratio of men and women, average age, number of observations, BMI and the volume of blood loss. The surgeon duration and the duration of the stationary phase in group I exceeded the similar parameters of the II group. The modified Rankin scale at admission and discharge in all patients showed moderate disability, starting indicators and results after 3 months were more prosperous in group II. Both groups had an equivalent score on the Harris scale before surgery and after 3 months after it, more pronounced positive dynamics of the quality of life on the EQ-5D scale ("thermometer") was noted in group II. A decrease in pain after surgery compared with baseline, with regression to 0.8-1.0 points by 3 months after surgery, was noted in all patients. The assessment on the rehabilitation routing scale did not differ in both groups. At the stationary stage, group I patients walked with additional support on crutches (100%), group II - on a cane (92.5%). On long days 4-6, 82.8% of patients of group I and 91.7% of patients of group II passed long distances. At the end of stage I rehabilitation, 83.7% of group I patients and 92.5% of group II were sent to the outpatient rehabilitation stage, the rest were transferred to stage II of rehabilitation in a 24 - hour hospital. The third stage of rehabilitation, all patients went on an outpatient basis at the place of residence. At the follow-up stage, the data of a telephone survey of group II were analyzed (n = 68, 25.6% of the respondents). By 3 months, the Harris score exceeds 90 points, satisfaction with the operation is 97%. As a result of the use of surgical MIS access for hip arthroplasty, all patients had good rehabilitation indicators. Conclusions. The general approach to managing patients after hip arthroplasty is similar for all types of surgical access, however, MIS-access creates the most favorable conditions for the rehabilitation of patients in the early postoperative period: a positive attitude of the patient, reduced blood loss, reduced surgical incision, the possibility of early activation and transition to the general regime for 6-7 days. The results of the study showed the advantages of a model for the organization of rehabilitation in the postoperative period after hip arthroplasty using mini-invasive access over standard surgical access. Group II patients (MIS access) had a higher level of physical activity and a low level of pain in the early postoperative period.

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).

scholarly journals Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fevzi Sarper Türker ◽  
Ayşe Doğan ◽  
Gonca Ozan ◽  
Kurtuluş Kıbar ◽  
Mine Erışır
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxidative Damage ◽  
Postoperative Period ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Early Postoperative Period ◽  
Open Heart ◽  
Arterial Blood ◽  
Antioxidant Parameters ◽  
Antioxidant Supplements

Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods.Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined.Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period.Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed.

scholarly journals Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy

2021 ◽  
Keyword(s):  
Postoperative Period ◽  
Inpatient Treatment ◽  
Fast Track ◽  
Early Postoperative Period ◽  
Wound Complications ◽  
Fast Track Surgery ◽  
Surgical Interventions ◽  
Group I ◽  
Laparoscopic Hernioplasty ◽  
Group Ii

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

scholarly journals Treatment of patients with occlusive-stenotic diseases of the arteries of the infrarenal aorta by the hybrid method

2021 ◽  
Vol 25 (4) ◽  
pp. 593-598
Author(s):  
V. V. Shaprynskyi
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Causes Of Death ◽  
Early Postoperative Period ◽  
Limb Amputation ◽  
Infrarenal Aorta ◽  
Hybrid Surgery ◽  
Common Causes ◽  
The Right ◽  
Stenotic Lesions

Annotation. The treatment results of patients with arterial occlusive-stenotic diseases of the lower extremities as a result of obliterating atherosclerosis were analyzed. 79 patients underwent hybrid surgery. Most patients were ranged in age from 46 to 86 years. There were 175 men (72.0%) and 68 women (28.0%). The right lower extremity was affected more often – 148(60.9%) patients than the left ones – 95(39.1%). Of the 20 patients with stenosis of the iliac-femoral segment, 14 hybrid surgeries were completed with stenting. Endarterectomy or profundoplasty with different angioplasty options were mainly performed. Endarterectomy or thrombectomy with various angioplasty options was mainly performed in the occlusion of the femoral-popliteal segment. The main hybrid type of operation in the popliteal segment was thrombectomy of the popliteal segment and balloon angioplasty of the tibial segment. In occlusive stenotic lesions of the arteries of the tibial-foot segment in the vast majority of cases, autovenous plastics of the tibioperoneal trunk with balloon angioplasty of distal arteries were performed. The thrombosis was diagnosed in 8(10,12%) individuals as the most common complication in the early postoperative period. Limb amputation was performed in 3 patients. Mortality rate in the early postoperative period was 4,76%(2 patients died in the comparison group), in the main group there was no mortality. Acute myocardial infarction and stroke are among the most common causes of death.

Sensor Fusion for Noninvasive Continuous Monitoring of Pulsating Blood Pressure Based on an Arterial Hemodynamic Model

1999 ◽  
Author(s):  
Boo-Ho Yang ◽  
Yi Zhang ◽  
Haruhiko H. Asada
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Continuous Monitoring ◽  
Arterial Blood Flow ◽  
Accurate Estimation ◽  
Internal Variables ◽  
Arterial Segment ◽  
New Approach ◽  
Arterial Blood ◽  
Hemodynamic Model

Abstract This paper presents a new approach to noninvasive, continuous monitoring of arterial blood pressure for advanced cardiovascular diagnoses. Most of the current noninvasive, continuous blood pressure measurement devices are mechanically intrusive and, therefore, cannot be used for long-term ambulatory monitoring. This new approach requires only simple, noninvasive monitoring devices such as finger photo plethysmographs and an electrical impedance plethysmograph (EIP) to monitor the dynamic behavior of the arterial blood flow. In this approach, measured signals from these noninvasive sensors on an arterial segment are integrated to estimate the blood pressure based on a hemodynamic model using a Kalman filter. It is shown that the internal variables such as the arterial blood pressure of the arterial segment can be estimated based on the measurements even though the observability condition of the system may not be met. Simulation results indicate that the approach can generate an accurate estimation of the arterial blood pressure in real-time even from noisy sensor signals.

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