RESULTS OF A SINGLE-STAGE REVASCULARIZATION AND SANATION OF PURULO-NECROTIC FOCUS IN PATIENTS WITH CRITICAL LOWER EXTREMITIES ISCHEMIA AGAINST THE BACKGROUND OF DIABETES MELLITUS

Abstract


Aim. To compare the efficiency of a single-stage and staged tactics of surgical treatment in patients with critical ischemia against the background of combined arterial bed lesion. Materials and methods. The results of examination and treatment of 86 patients with critical ischemia caused by combined lesion including type II diabetes mellitus and magistral atherosclerosis were studied. The preoperative diagnosis included ultrasonic dopplerography, duplex arterial scanning, aortoarteriography, estimation of foot and shin microcirculation using transcutaneous measurement of tissue oxygen tension. Critical ischemia corresponded to III–B–IV stage with severe purolo-necrotic process in the foot tissues (stage ID–IIID). According to the order and terms of performing surgical interventions, patients were divided into two groups: Ia (43) – sanation of purulo-necrotic focus was fulfilled simultaneously with revascularization, Ib (43) – inflammatory focus was liquidated either before or after the blood flow correction. Results. In subgroup Ia, the period for healing ulcerous and wound defects on the foot was 42,90±5,70 days; no lethal outcomes, hemorrhages and infection generalization was registered. An effective restoration of blood flow and preservation of extremity was reached in 97,67% of cases. In subgroup Ib, the results were the following: the healing period – 58,72±6,86 days, shunt thromboses – in 20,93% of cases, arrosive hemorrhages – 2,39% and progressive purulent process – 25,58%. An effective restoration of hemorrhage in subgroup Ib was reached in 81,39%, preservation of extremity in 90,69% of observations. Conclusion. A single-stage surgical tactics permitted to significantly decrease the number of vascular and purulent complications ( p =0,0074 and p =0,0008), to reduce the period for healing ulcerous defects ( p =0,040935) and to preserve the support ability of extremity in 97,67% of cases.

РЕЗУЛЬТАТЫ ОДНОМОМЕНТНОЙ РЕВАСКУЛЯРИЗАЦИИ И САНАЦИИ ГНОЙНО-НЕКРОТИЧЕСКОГО ОЧАГА У ПАЦИЕНТОВ С КРИТИЧЕСКОЙ ИШЕМИЕЙ НИЖНИХ КОНЕЧНОСТЕЙ НА ФОНЕ САХАРНОГО ДИАБЕТА

I A Berezina

Email: airinperm@yandex.ru

I S Mukhamadeev

L P Kotelnikova

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