Reoperations and operations, preventing thrombosis, in patients, suffering diabetes mellitus and critical ischemia of lower extremity
Objective. To determine the efficacy of reoperations and the thrombosis-preventive operations in patients with diabetes mellitus (DM) and chronic ischemia of the lower extremity (CHILE), comparing their results.
Маterials and methods. There was summarized the experience of treatment of 439 patients, suffering DM and CHILE with stenotic-occlusion affection (SOA) of the popliteo-tibial segment arteries in the Clinical Hospital «Feofaniya» of State Directorate for Affairs, Іnstitute of General and Urgent Surgery named after V. Т. Zaytsev NAMS of Ukraine and the Kyiv’s Municipal Clinical Hospital № 1 in 1999- 2016 yrs, to whom the open, endovascular and hybrid reconstructive operations on the lower extremities arteries were performed with the objective to improve the blood supply and elimination of the CHILE signs. The patients’ age was between 56 and 88 years old, and have constituted (67.9 ± 8.1) yrs old at average. There were 265 (60.4%) men and 174 (39.6%) women.
Results. Taking into account a high rate of the amputation conduction after second performance of reconstructive interventions - 24.6%, we proposed the examination algorithm for patients after primary operation, concerning the presence of the risk factors in them for the SOA and thrombosis occurrence in the arterial reconstruction zone (ARZ) and the ways of inflow and outflow. Basing on the algorithm elaborated, the indications were formulated for performance of operations, preventing thrombosis, results of which are better than those of reoperations.
Conclusion. Cumulative rate of the extremity preservation after reoperations in 1 and 3 years have constituted 75.4 and 49.2% accordingly. Taking into account a high rate of amputations performance after repeated reconstructive operations, the algorithm was proposed for the patients’ postoperative examination, depending on presence of the risk factors in them for the SOA and thrombosis occurrence on the ways of inflow and outflow and ARZ. Periodicity and methods of examination of the patients after performance of primary revascularization operations must be based on determination of the risk factors for the development of postoperative complications. Such a complex of diagnostic measures gives possibility to reveal a development of SOA in the inflow and the outflow arteries and immediately in ARZ, which precedes the thrombosis occurrence, and to administer the antithrombotic operation. The preventing thrombosis operations provide not only the ARZ thrombosis prophylaxis, but a clinical improvement as well, what was observed in 96.6% patients, while after reoperations - in 58.5% patients. Cumulative rates of the extremity preservation, after operations for the thrombosis prevention in 1 and 3 years, have constituted, accordingly, 98.3 and 91.5%, what significantly surpasses the analogous indices after reoperations.
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