Surgical Treatment Of Chronic Ischemia Research Articles

RESULTS OF INSPECTION AND TREATMENT OF PATIENTS WITH STENOSIS OF CAROTIDS IN COMBINATION WITH PATHOLOGIES OF OTHER SYSTEMS

Summary. An aim of work is an analysis of results of inspection and treatment of patients with the hemodynamically meaningful defeat of carotids in combination with pathology of other organs and systems. Materials and methods. The results of treatment are analysed 187 patients with hemodynamically by meaningful stenosis of carotids in SI «Zaycev V.T. IGUS of NAMSU» from 2015 for 2018 on a background forthcoming surgical treatment of chronic ischemia of lower limbs, ischemic heart or pathology of gastrointestinal tract trouble. Patients are divided into 3 groups. The first group was made by patients with the chronic ischemia of lower limbs of 2-Д degree - 167 patients. 7 patients entered a group with pathology of gastrointestinal tract. 3 a group was made by 13 patients with ischemic heart trouble. Results and discussion. The direct results of operation we estimated complex on the basis of degree of change of clinical status and presence of postoperative complications. At 161 the patients of the first group in a postoperative period are not educed complications, for a 2th patient thrombosis of anastamosis and ischemic stroke, at 4th paresis of n. Hypoglossuss. In the second group for all operated patients concerning stenosis of carotid, complications were not in a postoperative period. For one patient with the cancer of stomach, that was not execute a reconstructive operation on a carotid an ischemic stroke developed in connection with bleeding. In 3 cases in a postoperative period observed symptomatology of stroke for patients operated concerning ischemic heart, carotid endarterectomia was not executed these patients. Conclusions. To the patients with general atherosclerosis and stroke in anamnesis it is necessary to conduct carotids screening. At hemodynamically meaningful stenosises patients with heart diseaseby and pathology of abdomen of must execute carotid endarterectomia of the first stage, that reduces the risk of ischemic stroke in a postoperative period at treatment of basic pathology.

PROGRESS IN SURGICAL TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA

Aim. The study was conducted to expand the variety of ways for surgical treatment of chronic ischemia of lower limbs complicated by the involvement of the femoropopliteal and pedidial arterial segment. Materials and methods. The experience of surgical interventions in 43 male patients aged 52-75 suffering from chronic ischemia of lower limbs complicated by the atherosclerotic involvement of the femoropopliteal and pedidial segment has been summarized. According to the classification by A.V. Pokrovskiy, ischemia of the 3rd stage has been determined in 24 patients (55,8%), while ischemia of the 4th stage complicated by necrosis of the toes (critical ischemia) has been determined in other 19 patients (44,2%). All examined patients have undergone the reconstructive interventions using the prepared lateral subcutaneous vein of the upper extremity as a shunt.Results. During the first day after the operation, the regression of pain syndrome as well as the warming of the lower extremity was indicated in 93% of patients. In 8-12 days after the reconstructive operation, the patients have undergone the 15 necrectomy or toe amputation. In the nearest postoperative period (less than 6 months) no thrombotic complications in the reconstructed segment have been determined. Within the observation period from 6 months to 5 years the bypass patency has been preserved in 71% of patients; ischemia of the 2nd B type has been revealed in all patients with the preserved bypass patency by the clinical examination.Conclusion. Despite the “forced” character of usage of the prepared V. cephalica due to the absence of “traditional” venous shunts as well as the labor intensity of the method, it allows to expand the variety of ways for surgical treatment of patients suffering from chronic ischemia of lower limbs of the 3rd-4th stages complicated by occlusive involvements of the femoropopliteal and pedidial segment.

An Algorithmic Approach to the Surgical Treatment of Chronic Ischemia of the Hand: A Systematic Review of the Literature.

Chronic ischemia of the hand can lead to intractable pain, cold intolerance, and digital necrosis, affecting up to 4.8 percent of patients undergoing vascular surgery. Treatment of patients suffering from chronic hand ischemia, in particular, the subset of patients with a nonreconstructible distal arterial tree, can be a significant challenge for hand surgeons. The purpose of this systematic review is to analyze the outcomes of surgical therapies in an effort to define the efficacy of each intervention. The authors also revisit the treatment algorithm for nontraumatic chronic hand ischemia. A systematic search of the literature published since 1990 in the PubMed/MEDLINE database was performed using keywords. Articles were eligible if they described clinical studies of human patients with nontraumatic chronic hand ischemia who underwent sympathectomy, arterial bypass, or venous arterialization. Pain improvement, wound healing, and new ulcerations were primary outcome measures. Primary patency rates and limb salvage data were also collected as primary outcome measures in the bypass and arterialization study arms. For sympathectomy, arterial bypass, and venous arterialization, pain relief was achieved in 89, 100, and 100 percent of patients, respectively; whereas wound healing occurred in 74, 93, and 75 percent, respectively. Postoperative ulcerations were 0, 3, and 8 percent, respectively. No secondary amputations were reported in these 33 studies. Complication rates were moderately high (2.1 to 30.8 percent). This systematic review confirms that sympathectomy, arterial bypass, and venous arterialization are efficacious treatments, and allows for an algorithmic approach to the surgical treatment of chronic hand ischemia. Therapeutic, IV.