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 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 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 Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

2021 ◽  
Vol 88 (3-4) ◽  
pp. 21-27
Author(s):  
Yu. V. Ivanova ◽  
I. A. Kryvoruchko ◽  
V. A. Prasol ◽  
K. V. Miasoiedov ◽  
S. A. Andreieshchev
Keyword(s):  
Diabetes Mellitus ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Critical Ischemia ◽  
Diabetes Mellitus Type Ii ◽  
Indirect Revascularization ◽  
Autologous Mesenchymal Stem Cells

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix. Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted. Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

Importance of Non-Invasive Study of Microcirculation in the Limb at Assessment Amputation Level in the Patients with Critical Ischemia (Review)

10.12737/5685 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 1-5
Author(s):  
Петриевский ◽  
S. Petrievskiy ◽  
Сорока ◽  
V. Soroka ◽  
Нохрин ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Blood Circulation ◽  
Critical Role ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Diagnostic Methods ◽  
Critical Ischemia ◽  
Amputation Level ◽  
Social Burden ◽  
Non Invasive

The development of modern vascular surgery is impossible without improvement of diagnostic methods of examination. The development of severe disorders of blood circulation in limbs, beyond compensation, ends up executing amputation. In the present review the authors considered one of the current problems of modern vascular surgery - high amputation in patients with critical ischemia of lower extremities, the truncation of the leg. According to the majority authors, the main reason for early purulent - necrotic complications in high amputation is the mistake of determining the level of amputation. This fact is accompanied by a sharp reduction in the duration and quality of life, which entails increasing social burden and increases economic costs of rehabilitation of patients. One of the possible solutions to this problem is to study the safety regulatory mechanisms resistive Department microcirculation (arterioles, precapillary sphincters and metarterioles). This article presents the available arsenal of vascular surgery: methods of diagnostics of the microcirculation. It is proved the critical role of non-invasive methods for measuring microcirculatory disorders in critical limb ischemia (CLI) when the doctors choose the level of amputation. It is a comprehensive assessment of blood circulation in tissues and tissue metabolism allows to giving an objective answer on the degree of ischemic damage to the tissue in occlusive diseases of arteries of lower extremities.

scholarly journals WHO Surgical Complication Prevention Checklist: a Comparative Analysis of Two Clinics

2021 ◽  
Vol 14 (1) ◽  
pp. 33-41
Author(s):  
Machmud Vilevich Timerbulatov ◽  
Shamil Vilevich Timerbulatov ◽  
Timur Rustemovich Nizamutdinov ◽  
Vil Mamilovich Timerbulatov ◽  
Ekaterina Alexandrovna Grushevskaya
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Inpatient Treatment ◽  
Surgical Intervention ◽  
Surgical Complication ◽  
Surgical Interventions ◽  
Surgical Safety ◽  
Surgical Department ◽  
Who Checklist ◽  
Surgical Operations

The aim of the study was to examine the effectiveness of the adherence to the WHO surgical safety checklist.Material and methods. A comparative analysis of the performance of the surgical departments in two clinics was carried out: in the first clinic the WHO checklist was applied to control the performance of the surgical department; in the second clinic these recommendations were not used. The results of 3012 (first clinic) and 3527 surgical interventions (second clinic) were analyzed. The authors studied the frequency of postoperative complications, the effectiveness when using all the points of the recommendations.Results. The frequency of antibiotic prophylaxis during general surgical operations in clinic I was 89.3%, in clinic II - 63.7%, the frequency of infection in the area of ​​surgical intervention was by 13.2% and up to two times higher in clinic II, mortality rates after surgery were also significantly higher in clinic II; consequently, the duration of inpatient treatment was 8.7 in clinic I versus 16.4 days in clinic II.Conclusion. The adherence to the surgical safety checklist can effectively reduce the number of postoperative complications, mortality, and reduce the time of inpatient treatment.

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 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.

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