Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with lesions of the femoral-poplitealtibial arterial segment
Abstract
Background. An increase in the incidence rate of atherosclerosis
obliterans of the arteries of the lower extremities among patients with
diabetes mellitus and the peculiarities of vascular lesions in this
category of patients make it necessary to search for the most optimal tactics
of surgical treatment to preserve the limb during the development of critical
ischemia.
Aims - to increase the effectiveness of treatment of patients with critical
ischemia of the lower extremities of atherosclerotic genesis against the background
of diabetes in the near and long term. Material and methods. The study, conducted on the basis of clinical
hospitals in the city of Volgograd from 2012 to 2019, included 61 patients with
occlusive-stenotic lesions of the arteries of the femoral-poplitealtibial
segment of the lower extremities III-IV stages according to Fontaine-Pokrovsky
and diabetes mellitus revascularizing interventions. The study participants
were divided into two groups depending on the tactics of surgical
treatment undertaken. Patients of the 1st group (n=35) underwent only endovasal
revascularization, patients of the 2nd (n=26) group underwent hybrid operations combining open
reconstruction and transluminal balloon angioplasty. In the postoperative
period, the patients underwent conservative therapy and continued dynamic
observation.
Results. Over the entire observation period, patients of the 1st group
underwent 21 repeated interventions (60% of the number of primary operations),
of which 16 (45.7%) were performed on the limbs revascularized when
patients were included in the study, participants of the 2nd group
underwent 13 (50.0%) and 11 (42.3%) interventions respectively. 3 (8.6%)
patients of the 1st group and 2 (7.7%) patients of the 2nd group
required a large amputation at the level of the thigh or lower leg. Small
amputations were performed in 17 (48.6%) study participants from the 1st group,
13 (50.0%) from the 2nd. The mortality rate in the two groups
also did not have statistically significant differences.
Conclusions. For patients with critical lower limb ischemia and diabetes mellitus, both
isolated endovasal revascularization and a hybrid nature of the
intervention can be recommended. Strict dispensary observation of this
category of patients is necessary, including an assessment of the clinical
status of the lower extremities and the correction of the prescribed
pathogenetic therapy.
Keywords:diabetes mellitus, critical lower limb ischemia, hybrid interventions, endovascular surgery
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Frolov D.V., Mozgovoy P.V., Linchenko D.V., Frolov
M.V., Chernovolenko A.A., Dyachkova Yu.A., Obuhov A.D. Long-term results of
revascularization of the lower extremities in patients with critical ischemia
and diabetes mellitus with lesions of the femoral-popliteal-tibial
arterial segment. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9
(3): 104-11. DOI: https://doi.org/10.33029/2308-1198-2021-9-3-104-111 (in Russian)
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