Possibilities of Surgical Interventions in Severe Lower Limb Ischemia in the Stage of Trophic Disorders

Abstract

Occlusive pathology in the branches of aortic bifurcation or linear remains an urgent task of endovascular surgery in all highly developed countries throughout the world due to atherosclerotic narrowing of the vessels especially in the lower extremities. We have described the possibilities of surgical elimination of critical limb ischemia (CLI) in the stage of trophic disorders through the cohort study, which was conducted in the Grodno university clinic. The hospital and university committee approved the study. Within the last two years 2020-2022 in the hospital a total number of 68 patients were surgically treated for the CLI with trophic disorders. All of them were staged III-IV according to R.Fontine - A.V. Pokrovsky staging and ankle-brachial index (ABI). Aorto-femoral, Infrainguinally femoro-popliteal-tibial revascularization and transplantation of autologous venous allograft for the reconstruction of the lower extremities in the above mentioned patients were carried out. We obtained a very positive results, in 97.1% the patients had a limb with positive dynamics and its functional state was preserved. Only in 2 patients out of 66 which is 2.9%, the limb was amputated due to complications developed and inadequate revascularization. Based on our clinical observation we have proposed that, the use of autogenous venous material, modern original deobliterating reconstructions of arterial vasculature and transplantable allograft structures may be promising in the amelioration of occlusive pathology in severe life threatening lower limb ischemia in the stage of trophic disorders