Surgical treatment of stenotic–occlusive affections of the lower extremity arteries in patients, suffering ischemic form of the diabetic foot syndrome

Keywords: diabetes mellitus; critical ischemia of lower extremity; hybrid arterial reconstruction; diabetic foot syndrome

Abstract

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

  1. 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.
  2. 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.
  3. 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.

Author Biography

S. М. Didenko, Clinical Hospital «Feofania», Kyiv

Sergii N. Didenko, PhD, vascular surgeon,
department of vascular surgery,
Clinical Hospital «Feofaniya»
Address: 21 Zabolotnogo Str., 03143, Kyiv, Ukraina,
tel.: +38 (044) 259–65–74
E-mail: hirurgdidenko@gmail.com
ORCID: http://orcid.org/0000-0002-3115-7524

References

1. Zaremba VS, Myskiv AV, Kopyliuk YuI. Novi pidkhody do likuvannia ishemichnoi ta zmishanoi form syndromu diabetychnoi stopy. Klinichna farmatsiia, farmakoterapiia ta medychna standartyzatsiia. 2012;(1-2):117-22. [In Ukranian].
2. Mizhnarodna uhoda z problemy diabetychnoi stopy. Kyiv; 2004. 96 s. [In Ukranian].
3. Boiko VV, Ybrahymov RSh. Kompleksnoe lechenie sindroma diabeticheskoj stopy. Kharkivska khirurhichna shkola. 2009;(3):90–3. [In Russian].
4. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et. al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67. doi: 10.1016/j.jvs.2006.12.037.
5. Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer: a progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2012;28(Suppl.1):218-24. doi: 10.1002/dmrr.2255
6. Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005 Dec 3;366(9501):1925-34. doi: 10.1016/S0140-6736(05)67704-5.
7. Masaki H, Tabuchi A, Yunoki Y. Bypass versus endovascular therapy of infrapopliteal lesions for critical limb ischemia. Ann Vasc Dis. 2014;(7):227–31. doi: 10.3400/avd.oa.14-00070.
Published
2018-09-05
How to Cite
DidenkoS. М. (2018). Surgical treatment of stenotic–occlusive affections of the lower extremity arteries in patients, suffering ischemic form of the diabetic foot syndrome. Klinicheskaia Khirurgiia, 85(7), 39-42. https://doi.org/10.26779/2522-1396.2018.07.39
Section
General Problems of Surgery