Novosti
Khirurgii

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Year 2017 Vol. 25 No 2

GENERAL & SPECIAL SURGERY

V.I. RUSIN, V.V. KORSAK, P.A. BOLDIZHAR, V.V. RUSIN, M.I. PEKAR, F.V. GORLENKO, V.V. MASHURA, O.V. LANGAZO

LONG-TERM SURGICAL TREATMENT RESULTS OF CRITICAL LOWER LIMBS ISCHEMIA FOLLOWING SIMULTANEOUS DIRECT AND INDIRECT REVASCULARIZATION

SHEE “Uzhhorod National University”,
Uzhhorod,
Ukraine

Objectives. To optimize the tactics of surgical treatment in patients with chronic lower limb ischemia through the development and implemention into the clinical practice of simultaneous combination of direct and indirect methods of revascularization.
Methods. The results of surgical treatment of patients (n=181) have been studied and analyzed; the patients underwent the combined direct and indirect revascularization of the lower limbs. Depending on the type of surgical treatment the patients were divided into two groups: group I – 54 patients who underwent distal (below the knee) bypass surgery simultaneously with a rotary osteotrepanation of the tibia (ROT); group II – 62 patients who underwent profundoplasty simultaneously with ROT. For comparison group III (control) with 65 patients was formed where distal bypass grafting (below the knee) was performed. The long-term results were studied in 47 patients in group I, in 49 – group II and in 53 patients in group III.
Results. Within the 5-year observation the passability after the distal femoropopliteal bypass was registered in 49,4%, the limbs were saved in – 69,1% of cases. In the control group those figures were 43,7% and 55,2%, respectively. After tibial bypass the passability within 5 year observation in the first group was 16,8%, in the control group – 14,3% of cases. It managed to save the limbs in 36,1% of the operated patients and 24,2%, respectively. In the second group of patients who underwent profundoplasty and a rotary osteotrepanation, the index of the surviving limbs made up 56,3%, which is almost twice more as the index of the surviving limbs after tibial bypasses.
Conclusion. The effectiveness of indirect revascularization after the restoration of arterial inflow is considered to be more predictable than its performing in isolated form under the conditions of critical limb ischemia.The combination of direct and indirect methods of revascularization is thought to provide a higher positive result in the late incisional period and increases the rate of the saved limbs.

Keywords: chronic critical arterial ischemia, femoral-popliteal-tibial segment, direct and indirect revascularization interventions, tibial bypasses, incisional period, effectiveness, mortality
p. 131-139 of the original issue
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Address for correspondence:
88000, Ukraine, Zakarpatskaya region,
Uzhgorod, Narodnaya sq., 1,
SHEE «Uzhhorod National University»,
Medical Faculty
department of surgical diseases.
Tel.: + 38095-553-20-32
e-mail: m_pekar@mail.ru
Mikhail I. Pekar
Information about the authors:
Rusin V.I. MD, Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Korsak V.V. MD, Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Boldizhar P.A. MD, Professor, Head of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Rusin V.V. MD, Ass. Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Pekar M.I. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Gorlenko F.V. PhD, Ass. Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Mashura V.V. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Langazo O.V. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
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