The hybrid arterial reconstruction in treatment of patients, suffering the ischemic form of the diabetic foot syndrome and multi–level stenotic–occlusive affection of the lower extremity arteries

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

Abstract

Objective. Analysis of results of surgical treatment in patients, suffering ischemic form of the diabetic foot syndrome (IF DFS) and multilevel stenotic–occlusive affection (SOA) of the lower extremity arteries.

Materials and methods. There were analyzed the results of surgical treatment in 164 patients, suffering diabetes mellitus (DM) of the Type II, complicated by IF DFS, and chronic critical ischemia of the lower extremity on background of the combined SOA of arteries of femoral and popliteo–tibial segments (PTS). The patients were divided into three Groups in accordance to the operation performed. Into Group I 61 patients were included, to whom open arterial reconstruction in femoral segment without intervention on the PTS arteries was performed; to Group II – 38 patients, in whom open two–level arterial reconstruction was done; to Group III – 65 patients, in whom a hybrid arterial reconstruction was performed.

Results. In the Group I patients the index of primary passability of the femoral reconstrucrion zone have constituted 65.6%, secondary – 81.9%, the high amputation part – 18%, mortality – 11.5%; in the patient of Group II – 89.5, 92.1, 5.2 and 7.9% accordingly; in the patients of Group III – 81.5, 93.9, 7.7 and 4.6% accordingly.

Conclusion. In the patients, suffering combined SOA in the PTS arteries and superficial femoral artery (SFA) the isolated restoration of SFA passability without intervention on the  PTS arteries have appeared not sufficient, witnessed by trustworthily highest mortality – 11.5% and percentage of high amputations performed– 14.8% (p < 0.001). The indices of primary and secondary passability of the arterial reconstruction zone and percentage of high amputations performed after open two–level and the hybrid reconstructive operations are quite similar – 89.5 and 81.5%, 94.7 and 96.9%, 2,6 and 3.1% accordingly (p > 0.05). While mortality after open two–level operations is trustworthily higher, than after the hybrid reconstructive – 7.9 and 4.6% accordingly (p < 0.05). That is why in the combined SOA of SFA and arteries of PTS the performance of the hybrid arterial reconstruction must be regarded first of all as optimal surgical tactic.

Author Biography

S. M. Didenko, Clinical Hospital «Feofania», Kyiv, Ukraine

Didenko S.M., PhD, MD, vascular surgeon,
Department of vascular surgery,
Clinical Hospital «Feofaniya»
21 Zabolotnogo Str., 03143, Kyiv, Ukraine,
tel: +38 (044) 259–65–74, +38 (095) 643-43-34.
е-mail: hirurgdidenko@gmail.com
ORCID ID: 0000-0002-3115-7524

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Published
2019-09-28
How to Cite
Didenko, S. M. (2019). The hybrid arterial reconstruction in treatment of patients, suffering the ischemic form of the diabetic foot syndrome and multi–level stenotic–occlusive affection of the lower extremity arteries. Klinicheskaia Khirurgiia, 86(9), 16-21. https://doi.org/10.26779/2522-1396.2019.09.16
Section
General Problems of Surgery