Novosti
Khirurgii

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Year 2013 Vol. 21 No 2

GENERAL AND SPECIAL SURGERY

I.N. IGNATOVICH1 , G.G. KONDRATENKO1 , D.D. NIKULIN2

JUSTIFICATION FOR THE OPTIMAL TREATMENT METHOD OF PATIENTS WITH DIABETIC NEUROISCHEMIC FOOT SYNDROME BASED ON COMPARISON OF LONG-TERM RESULTS OF VARIOUS METHODS APPLICATION

EE “Belarusian State Medical University”1,
ME “Minsk 11th City Clinical Hospital” 2,
The Republic of Belarus

Objectives. To justify the optimal treatment method of patients with neuroischemic form of diabetic foot syndrome having compared the long-term results (3 years) of two different application methods: conservative or surgical (the lower limb revascularization).
Methods. The data presented in the article are the completion of the research aimed to determine the optimal treatment method in patients with neuroischemic form of diabetic foot syndrome; intermediate results of this research have been published earlier.
Two groups of patients with neuroischemic form of diabetic foot syndrome were singled out to compare the treatment results: the control group and the comparison group. The patients of the control group (numbering 110) underwent only conservative treatment. The lower limb revascularization has performed to stop the critical ischemia in patients of the comparison group (numbering 48).
Results. During 3 years 65 out of 110 persons died in the control group. In 25 out of 45 staying alive patients (55,6%) we managed to save the supporting function of the foot and avoid the lower limb high amputation. During 3 years 9 out of 48 patients died (18,8%) in the comparison group. In 28 out of 39 staying alive patients (71,8%) we managed to save the supporting function of the foot and avoid the lower limb high amputation. The number of major amputations in the control group was reliably higher than in the comparison group. In the long-term results the number of ulcerous-necrotic lesions of the foot and the patients with the pain syndrome at rest condition was reliably higher in the control group. The parameters of life quality were better in the comparison group.
Conclusions. Revascularization is considered as an optimal and effective method of critical ischemia treatment and saving of the limb supporting function at neuroischemic form of diabetic foot syndrome.

Keywords: diabetic foot syndrome, revascularization, amputation, life qualitys
p. 69 – 75 of the original issue
References
  1. Pashkevich LA, Mokhammadi MT, Ignatovich IN, Martyniuk SN. Patomorfologiia diabeticheskoi neiropatii [Pathologic morphology of diabetic neuropathy]. ARS medica. 2010;(9):187–92.
  2. Shor NA, Chumak IuF, Reuka VP, Zhukov OA. Revaskuliarizatsiia nizhnikh konechnostei pri ishemicheskoi forme diabeticheskoi stopy s gnoino-nekroticheskimi porazheniiami tkanei [Revascularization of the lower limbs for ischemic diabetic foot with pyonecrotic tissue lesions ]. Angiologiia i Sosud Khirurgiia. 2004;10(4):85–90.
  3. Chur NN, Grishin IN, Kazlovskii AA, Kokoshko IuI. Etiologiia, patogenez, klassifikatsiia i khirurgicheskoe lechenie sindroma diabeticheskoi stopy [The etiology, pathogenesis, classification and surgical treatment of diabetic foot syndrome]. Khirurgiia Zhurn im NI Pirogova. 2003;(4):42–6.
  4. Malakhov IuS, Aver'ianov DA, Ivanov AV. Analiz rezul'tatov khirurgicheskogo lecheniia bol'nykh s gnoino-nekroticheskimi porazheniiami nizhnikh konechnostei ishemicheskogo geneza [Analysis of the results of surgical treatment of pyonecrotic tissue lesions of the lower limbs ischemic]. Angiologiia i Sosud Khirurgiia. 2009;(1):133–38.
  5. Ol'shanskii MS, Esipenko VV, Ivanov AA, Moshurov IP, Kazanskii DV. Endovaskuliarnaia korrektsiia mnogoetazhnogo porazheniia arterii pri kriticheskoi ishemii nizhnei konechnosti u bol'nogo pozhilogo vozrasta [Endovascular correction of multi-storey arterial lesions in elderly patients with critical limb ischemia]. Angiologiia i Sosud Khirurgiia. 2007;13(2):42–44.
  6. Ignatovich IN, Kondratenko GG, Sergeev GA, Kornievich SN, Khrapov IM. Rezul'taty lecheniia patsientov s khronicheskoi kriticheskoi ishemiei pri neiroishemicheskoi forme sindroma diabeticheskoi stopy [The results of treatment of patients with chronic critical ischemia at diabetic neuroischemic foot]. Khirurgiia Zhurn im NI Pirogova. 2011;(6):51–55.
  7. Ferraresi R, Centola M, Ferlini M, Da Ros R, Caravaggi C, Assaloni R, Sganzaroli A, Pomidossi G, Bonanomi C, Danzi GB. Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2009 Mar;37(3):336–42.
  8. Khamitov FF, Dibirov MD, Briskin BS i dr. Vozmozhnosti khirurgicheskoi revaskuliarizatsii pri gnoino-nekroticheskikh oslozhneniiakh sindroma diabeticheskoi stopy [The possibilities of surgical revascularization in necrotic complications of diabetic foot]. Al'm in-ta khirurgii im AV Vishnevskogo. 2009;4(2):209–10.
  9. De Rubertis BG, Chaer RA, Hynecek R, Benjelloun R, Karwowski J. Effect Of Diabetes On Outcome Of Percutaneous Lower Extremity Intervention. NESVS Annual Meeting: Abstracts. 2006. ð. 25.
  10. Gavrilenko AS, Skrylev SI. Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei, obuslovlennoi porazheniiami arterii infraingvinal'noi lokalizatsii [Surgical treatment of patients with critical ischemia of the lower limbs due to arterial lesions of infrainguinal localization]. Angiologiia i Sosud Khirurgiia. 2008;14(3):111–17.
  11. Dibirov MD, Briskin BS, Khamitov FF, Proshin AV, Iakobishvili IaI. Rol' rekonstruktivnykh sosudistykh operatsii u bol'nykh diabeticheskoi angiopatiei [The role of reconstructive vascular surgery in patients with diabetic angiopathy]. Khirurgiia Zhurnal im NI Pirogova. 2009;(2):59–63.
  12. Blevins WA, Schneider PA. Endovascular management of critical limb ischemia. Eur J Vasc Endovasc Surg. 2010 Jun;39(6):756–61.
  13. Mofidi R, Flett M, Nagy J, Ross R, Griffiths GD, Chakraverty S, Stonebridge PA. Balloon angioplasty as the primary treatment for failing infra-inguinal vein grafts. Eur J Vasc Endovasc Surg. 2009 Feb;37(2):198–205.
  14. Clair DG, Dayal R, Faries PL, Bernheim J, Nowygrod R, Lantis JC 2nd, Beavers FP, Kent KC. Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia. Ann Vasc Surg. 2005 Jan;19(1):63–8.
  15. Wolfle KD, Bruijnen H, Loeprecht H, Rumenapf G, Schweiger H, Grabitz K, Sandmann W, Lauterjung L, Largiader J, Erasmi H, Kasprzak PM, Raithel D, Allenberg JR, Lauber A, Berlakovich GM, Kretschmer G, Hepp W, Becker HM, Schulz A. Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis. Eur J Vasc Endovasc Surg. 2003 Mar;25(3):229–34.
  16. Tarakanova OE, Mukhin AS, Smirnov NF. Vliianie kriticheskoi ishemii konechnostei na techenie ranevogo protsessa i chastotu vysokikh amputatsii pri gnoino-nekroticheskikh formakh diabeticheskoi stopy [The influence of critical limb ischemia at the wound process and frequency of high amputations in diabetic pyonecrotic foot]. Angiologiia i Sosud Khirurgiia. 2009;15(4):15–18.
  17. Ignatovich IN, Kondratenko GG, Nikulin DD, Iakovlev AV. Otsenka effektivnosti razlichnykh podkhodov k lecheniiu patsientov s neiroishemicheskoi formoi sindroma diabeticheskoi stopy (promezhutochnye itogi) [Assessment of the effectiveness of different approaches to the treatment of patients with diabetic neuroischemic foot (intermediate outcomes)]. Novosti Khirurgii. 2011;19(2):60–65.
  18. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997 Sep;26(3):517–38.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO «Belorusskii gosudarstvennyi meditsinskii universitet», 1-ia kafedra khirurgicheskikh boleznei,
e-mail: ini67@inbox.ru,
Ignatovich Igor' Nikolaevich
Information about the authors:
Ihnatovich I.N. PhD, associate professor of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Kondratenko G.G. MD, professor, head of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Nikulin D.D. A physician of the surgical department of ME “Minsk 11th city clinical hospital”.
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