scholarly journals ТHE PLACE OF ENDOVASCULAR SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

2020 ◽  
pp. 94-98
Author(s):  
V. B. Goshchynsky ◽  
O. B. Lugovyj ◽  
S. O. Lugovyj ◽  
U. M. Herasimets
Keyword(s):  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Lower Extremities ◽  
The Elderly ◽  
Endovascular Surgery ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Ischemia Of The Limbs ◽  
Analysis Of Results ◽  
Late Postoperative Period

Summary. The purpose of the study. To determine the possibility of endovascular surgical interventions and their effectiveness in patients with critical ischemia of the limbs. Materials and methods. The object of research was 209 patients with critical ischemia of the limbs, ages 53 to 71 years, which made endovascular surgical interventions. The results. Analysis of results of endovascular surgery witness that balloon angìoplasty with stenting zone for reconstruction and balloon angìoplasty with paclitaxel give the smallest percentage of reocclusion and restenosis in the early and late postoperative period than balloon angìoplasty. Conclusions. 1. The use of endovascular surgical interventions is a promising method of treatment of critical ischemia of the lower extremities, especially in the elderly and senile. 2. In case of critical ischemia of the limbs should be used balloon angìoplasty with stenting or balloon angìoplasty with paclitaxel, based on the results of early and late postoperative period.

Evaluation of the results of planned open surgical interventions in primary chronic vein disease in pregnant women

2020 ◽  
pp. 51-56
Author(s):  
V.М. Аntonyuk-Kysil ◽  
◽  
І.Y. Dziubanovskyi ◽  
V.М. Yenikeeva ◽  
S.І. Lichner ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Postoperative Period ◽  
Postpartum Period ◽  
Clinical Manifestations ◽  
Lower Extremities ◽  
Vascular Surgeon ◽  
Surgical Interventions ◽  
Perinatal Center ◽  
Vein Disease

The objective: to evaluate the results of planned open surgical interventions (POSI) in pregnant women with primary symptomatic chronic vein disease (PSCVD). Materials and methods. The study included 457 pregnant women operated on a routine basis with PSCVD. The patients underwent ultrasound duplex angioscanning (USDA) of the veins of the lower extremities, inguinal canals, and iliac veins. The severity of the clinical manifestations of PSCVD was evaluated on a VCSS scale. With the help of the circadian visual-analog scale, the dynamics after the operative pain were studied. The effect of POSI on uterine tone and cardiac function of the fetus was investigated using cardiotocography. When forming the results for POSI, data from USDA, the severity of clinical and cosmetic manifestations of PCVD, the need for active prevention of thrombophlebetic, thromboembolic and hemorrhagic complications, minimization of surgical childbirth were taken into account. The results of treatment were studied in 2 groups of patients. Patients of the first group were treated with conservative therapy, the second group – POSI. Parametric indicators, which were presented as mean and standard error M(SD), were used for statistical data processing of the study, and their reliability was estimated using Student’s t-test. The species was determined to be significant at p<0.05. Results. 495 POSI were performed at 28-38 weeks gestation in an obstetric hospital (perinatal center), by a vascular surgeon from the staff of the center, who was familiarized with the peculiarities of working with this contingent of patients. Surgery was performed under local anesthesia in 346 (75.49%) pregnant women at one extremity, in 111 (24.51%) – at two in one session. According to the results of the study, it was noted that in the first group 33.7% of patients had a positive clinical result due to the reduction of pain syndrome, while 67.5% of patients had an increase and spread of varicose transformation in the area of saphenous and/or non-saphenous veins with spread of pathological venous reflux in the distal direction. 78% of patients had the need to administer prophylactic doses of low molecular weight heparins, both during pregnancy and in postpartum period. Out of 126 pregnant women with pronounced varicose veins of the external genital organs and perineum in 36 (28.6%) deliveries were performed by caesarean section. In 9 (3%) patients there was an acute thrombophlebitis of the subcutaneous veins of the lower extremities, which required 5 pregnant women to undergo urgent surgery when the inflammatory process had spread to the middle and above along the femoral vein of the large subcutaneous vein. Pregnant women of the second group with PSCVD on the basis of obstetric hospital (perinatal center) POSI were performed in the organization, which laid the ideology of the FTS program, strictly individual indications for intervention in the optimal terms of pregnancy, multidisciplinary management of patients, due to this in 93% of operated patients regression of clinical manifestations of the disease was noted, whch contributed to the correct and safe delivery of pregnancy with 100% absence of preterm birth, abnormalities in fetal development, pregnancy course, negative impact on obstetric and somatic condition of the pregnant woman. No hemorrhagic, thrombophlebic, thromboembolic complications were noted. Patients in the postoperative period did not require medical support, as during the period of pregnancy, during delivery and in the postpartum period. There were no indications for surgical delivery. 2.4% of patients experienced complications of post-operative wounds in the form of cheese, which had no effect on pregnancy and was eliminated before delivery. In the postoperative period, if necessary, it was recommended to use elastic compression class garments 1–2. Conclusion. POSI made at PSCVD in optimal terms of pregnancy in a specialized obstetric hospital by a vascular surgeon in strictly individual indications is safe, both for the fetus and the pregnant woman. It is promising to further study the results of POSI in pregnant women with PSCVD to introduce it into the arsenal of treatment of this pathology. Key words: FTS ideology, planned open surgical interventions in pregnant women.

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.

Use of allogeneic cartilage in reconstruction surgery of laryngeal and tracheal stenosis

2021 ◽  
Vol 20 (3) ◽  
pp. 33-38
Author(s):  
E. A. Kirasirova ◽  
◽  
N. V. Lafutkina ◽  
R. F. Mamedov ◽  
R. A. Rezakov ◽  
...  
Keyword(s):  
Tracheal Stenosis ◽  
Reconstructive Surgery ◽  
Postoperative Period ◽  
Disease Duration ◽  
Surgical Interventions ◽  
Reconstruction Surgery ◽  
Highly Effective ◽  
Partial Resorption ◽  
Late Postoperative Period

This article analyzes the increasing effectiveness of extensive defects and chronic cicatricial laryngeal and tracheal stenosis treatment with the allogeneic cartilage implantation. The study included 63 patients with an age interval of 18–65 years and a disease duration from 3 months to 6 years. Radiologic, functional and endoscopic investigations were carried out, after which the patients underwent laryngotracheoplasty using allogeneic cartilage, which has low antigenicity, affects the growth of the recipient’s tissues and prevents scarring. After the discharge, a dynamic outpatient observation was carried out: 2 times a week – 10 days; once a week – 21 days, once a month - 6 months. The study revealed that a differentiated approach to the treatment of patients with stenosis of the laryngeal-tracheal complex using the allogeneic cartilage made it possible to fully rehabilitate of 59 (94%) of 63 patients (100%). Only 4 (6%) patients had partial resorption or rejection of implanted cartilaginous allografts that led to the failure of the laryngeal and tracheal walls in the late postoperative period. The use of the allogeneic cartilage implantation in reconstructive surgery has proved to be highly effective in the laryngeal and tracheal framework defects, resulted from prolonged stenosis, major surgical interventions, and trauma.

scholarly journals Repair of Saphenofemoral Transition: Reşat Operation for Patients With Venous Reflux

2018 ◽  
Vol 102 (9-10) ◽  
pp. 446-458
Author(s):  
Ilker Alat
Keyword(s):  
Postoperative Period ◽  
Valsalva Maneuver ◽  
Color Doppler ◽  
Early Postoperative Period ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
First Choice ◽  
Physical Examinations ◽  
Late Postoperative Period

Objective: To develop a new solution superior to the current surgical interventions in patients with venous reflux in the great saphenous vein (GSV). Materials and Methods: Patients with the symptoms of venous incompetence in their legs like pain, edema, and cramp were also examined with color Doppler ultrasonography (CDU). One hundred ninety-one extremities with venous reflux at the saphenofemoral transition (SFT) were subjected to surgery over 8 years. A newly designed operation, the Reşat operation, was performed in all of the patients. The Reşat Operation was performed only in the patients with continuous reflux at their saphenofemoral transition during the entire Valsalva maneuver. The follow-up time spanned more than 8 years. The patients' complaints, physical examinations, and CDU findings were evaluated. Results: All of the patients had continuous reflux at the SFT for the duration of the entire Valsalva maneuver preoperatively. However, 67.88% of the patients had no reflux postoperatively (P &lt; 0.001). Additionally, 95.76% of the patients recovered to different degrees in the early postoperative period ultrasonographically (P &lt; 0.001). All of the patients reported being satisfied with the result in the early postoperative period (P &lt; 0.001). In the late postoperative period, although the CDU reports of some patients showed reflux at the GSV, no patient complained about their condition. Conclusion: The Reşat operation is a well-tolerated operation and reconstitutes the saphenofemoral transitions successfully. Its early and late postoperative results are satisfactory. The Reşat operation should be the first-choice surgical treatment in patients with venous reflux at the saphenofemoral transition.

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.

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.

Endovascular surgery for critical ischemia of lower extremities with suppurative-necrotic lesion of the feet

2017 ◽  
pp. 4
Author(s):  
K. V. Lipatov ◽  
S. V. Permyakov ◽  
A. G. Asatryan ◽  
A. V. Borodin ◽  
V. K. Gostishchev
Keyword(s):  
Lower Extremities ◽  
Necrotic Lesion ◽  
Endovascular Surgery ◽  
Critical Ischemia

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.

Long-term outcome of low-cost glaucoma drainage device (Aurolab aqueous drainage implant) compared with Ahmed glaucoma valve

2019 ◽  
Vol 104 (4) ◽  
pp. 557-562 ◽  
Author(s):  
Surinder Singh Pandav ◽  
Natasha Gautam Seth ◽  
Faisal Thattaruthody ◽  
Manpreet Kaur ◽  
Madhuri Akella ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Low Cost ◽  
Glaucoma Drainage Device ◽  
Ahmed Glaucoma Valve ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Surgical Interventions ◽  
Drainage Device ◽  
Late Postoperative Period

PurposeTo compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glaucoma valve (AGV).MethodRetrospective analysis of patients with refractory glaucoma who underwent AGV (AGV-FP7) and AADI (AADI Model 350) implantation. The outcome measures were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs) and re-surgery for IOP control. The postoperative complications were classified as early (≤3 months), intermediate (>3 months to ≤1 year) or late (>1 year).Results173 patients (189 eyes) underwent AGV implantation (AGV Group) while 201 patients (206 eyes) underwent AADI implantation (AADI group). The IOP in AADI group was significantly lower than AGV group at all time points till 2 years and comparable at 3 years. AADI group had significantly higher number of AGM in preoperative period and significantly lower number in postoperative period till 3 years compared with AGV group. AADI group had more hypotony-related complications but statistically insignificant (p = 0.07). The surgical interventions were significantly higher in AGV (n = 18) compared with AADI group (n = 5) in late postoperative period (p = 0.01). At 3 years, overall success was seen in 58.18% in AGV and 73.08% in AADI group (p = 0.15). Complete success was seen in 7.27% patients in AGV and 25.00% patients in AADI group (p = 0.02).ConclusionBoth AADI and AGV implant had comparable mean IOP at 3 years with lesser requirement of AGM in the AADI group. Both procedures appear to be safe with slight preponderance of hypotony-related complications in AADI group.

scholarly journals THE PROBLEMS OF REHABILITATION OF THE PATIENTS AFTER THE EXTREMITY AMPUTATION

2009 ◽  
Vol 17 (1) ◽  
pp. 115 ◽  
Author(s):  
P. G. Shvalb ◽  
C. B. Baranov
Keyword(s):  
Lower Extremity ◽  
Postoperative Period ◽  
Lower Extremities ◽  
Critical Ischemia ◽  
Local Complications ◽  
Methods Of Treatment ◽  
Extremity Amputation

Quality of a life of patients with a chronic critical ischemia of the lower extremities and an ineffectual attempt of the restoration of a blood-groove before amputation, after amputation and at a stage of prosthetics with the help of own questionnaire with special specificity is analysed. The indications to the amputation and reamputation the of the lower extremity are formulated. It is shown, that the duly and correctly executed amputation without the general and local complications in the postoperative period though results to the disablement (invalidisation), but as it is paradoxical sounds, it improves some aspects of quality of a life of the patient. Therefore the amputation is one of regular, though also undesirable methods of treatment of patients in a stage of a critical ischemia. The conclusion is made, that process of rehabilitation of patients in a stage of a critical ischemia with ineffectual attempt of restoration of a blood-groove after the extremity amputation depending on a way of movement proceeds during 2 periods.

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