Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

Keywords: critical ischemia of the lower extremities; distal autovenous femoro-tibial shunting; transcutaneous pressure of oxygen; angiosoma.

Abstract

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice.

Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment.

Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients.

Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients.

Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Author Biographies

M. M. Lopit, Uzhgorod National University

Lopit Mikhail Mikhailovich, MD, Postgraduate student
Department of Surgical Diseases
Medical Faculty of Uzhhorod National University
22 Victory str., Uzhhorod 88018, Zakarpattia region, Ukraine
+38 0671188100; +38 (0312) 61-35-70
lopitmykhailo@gmail.com, kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0002-6425-2990

V. І. Rusyn, Uzhgorod National University

Rusyn Vasyl Ivanovych, MD, DSci(Med), Professor
Professor of the Department of Surgical Diseases
Medical Faculty of Uzhhorod National University,
22 Victory str., Uzhhorod 88018, Zakarpattia region, Ukraine
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0001-5688-9951

P. A. Boldizhar, Uzhgorod National University

Boldizhar Patricia Alexandrovna, MD, DSci(Med), Professor
Head of the Department of Surgical Diseases
Medical Faculty of Uzhhorod National University,
22 Victory str., Uzhhorod 88018, Zakarpattia region, Ukraine
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua, patricia.boldizhar@gmail.com
https://orcid.org/ 0000-0002-6295-5692

F. V. Gorlenko, Uzhgorod National University

Gorlenko Fedor Viktorovich, MD, DSci(Med)
Department of Surgical Diseases,
Medical Faculty, Uzhhorod National University.
22 Victory str., Uzhhorod 88018, Zakarpattia region, Ukraine
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0002-0496-2069

O. M. Kochmar, Uzhgorod National University

Kochmar Alexander Mikhailovich, MD, PhD,
Department of Surgical Diseases,
Medical Faculty, Uzhhorod National University.
22 Victory str., Uzhhorod 88018, Zakarpattia region, Ukraine
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0003-4040-7561

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Published
2021-07-28
How to Cite
Lopit, M. M., RusynV. І., Boldizhar, P. A., Gorlenko, F. V., & Kochmar, O. M. (2021). Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization. Klinicheskaia Khirurgiia, 88(3-4), 28-34. https://doi.org/10.26779/2522-1396.2021.3-4.28
Section
General Problems of Surgery

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