Comparative estimation of results of surgical and conservative treatment in patients, suffering diabetes mellitus and chronic critical ischemia of the lower extremity
Objective. To compare the results of conservative treatment and endovascular and open surgical interventions in patients, suffering diabetes mellitus and chronic critical ischemia of the lower extremity.
Materials and methods. The results of treatment of 240 patients, suffering diabetes mellitus type II and chronic critical ischemia of the lower extremity (CHCILE), ulcerative-necrotic affection of the foot on background of stenotic-occlusive affection of arteries of popliteal-ankle-foot segment were analyzed. Surgical treatment was conducted in 143 (54.6%) patients (Group A), and a conservative one - in 97 (40.4%) (Group B). Group A was divided into two Subgroups: A1 - 42 (29.4%) patients, to whom shunting operation to the ankle or the foot arteries was coducted, and A2 - 101 (70.6%) patients, to whom the balloon angioplasty was performed. With the objective for adequate comparison of results a coefficient of the amputation level (KAL) calculation was elaborated with the objective to compare the results of various kinds of treatment correctly.
Results. Of 42 patients of the Subgroup A1 in 4 (9.5%) amputation on the hip level was done, in 3 (7.1%) - on the ankle level, in 6 (14.3%) - transmetatarsal resection of the foot, in 14 (33.3%) - the fingers amputation. In 15 (35.7%) patients the foot supporting function did not disorder. The KAL value in patients of the Subgroup A1 have constituted 1.48. Of 101 patients of the Subgroup A2 in 2 (2.0%) the amputation was performed on the hip level, in 4 (4.0%) - on the ankle level, in 16 (15.8%) - transmetatarsal resection of the foot, in 19 (18.8%) - the fingers amputation. In 60 (59.4%) patients a supporting function of the foot did not disorder. The KAL value in patients of the Subgroup A2 have constituted 0.78. Of 97 patients of the Group B in 22 (22.7%) amputation on the hip level was performed, in 29 (29.9%) - on the ankle level, in 6 (6.2%) - transmetatarsal resection of the foot, in 11 (11.3%) - the fingers amputation. In 29 (29,9%) patients the foot supporting function did not disorder. The KAL value in patients of the Group B was 2.79.
Conclusion. The procedure was elaborated for the KAL value calculation, which may be applied for comparison of the patients’ treatment results, who suffer DM and CHCILE on background of stenotic-occlusive affection of arteries of the popliteal-ankle-foot segment, in whom various methods of treatment were used. Best one-year results of preservation of the lower extremity supporting function were observed in patients, in whom the balloon angioplasty performed, while the worst - in patients, in whom conservative treatment was conducted.
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