[Surgical treatment of patients with chronic critical ischemia of legs, caused by atherosclerosis].
208 patients with primary chronic critical ischemia of lower extremities (CCILE) were operated on from 1988 to 1995. The criteria of CCILE were the following: ischemia of an extremity in rest with specific ischemic pain for more than 2 weeks; existence of ulcernecrotic changes in distal parts of the extremity; brachiommalleous index (BMI) less than 0.35; malleous systolic pressure less than 50 mm Hg. Functional condition of the patients corresponded to class 3A, B and 4. The share of patients with CCILE among patients with lower extremities arterial lesions was 35%. In 150 (72%) of them there were lesions of aorto-illo-femoral-tibio-popliteal segment; in 58 (28%)-damage of a femoral-popliteal-tibial segment. The number of patients with trophic changes appear in early stage. 154 reconstructive operations have been performed in patients with multiple arterial lesions higher and lower of the Poupart's ligament, and only one primary amputation and sympathectomy. In 63 (42%) of the patients the "two-floor" reconstruction has been performed. In 142 (92%) of the cases positive results have been achieved. In 78.5% cases the grafts were competent a year after the surgery and the extremities were saved in 88% of the patients. 60 reconstructive operations, 3 primary amputations and 1 sympathectomy have been performed in patients with the lesions, located lower than Poupart's ligament. In 58 (96%) of the patients positive results were achieved. One year after surgery the grafts patency was 63.5%, and extremities were saved in 79% of the patients. The immediate and long-term follow-up results of femoral-politeal and femoral-tibial grafting did not differ significantly. Long-term follow-up results were better in case of less duration of CCILE before surgery. Adequate revascularisation of the extremity is an optimal method of treatment of patients with CCILE.
Belov
I V
IV
Scientific Center of Surgery.
Sandrikov
V A
VA
Kosenkov
A N
AN
Nazarov
A B
AB
Stepanenko
A B
AB
Minkina
S M
SM
Baimagambetov
A K
AK
D000671:Amputation, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001783:Blood Flow Velocity; D002908:Chronic Disease; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods; D016896:Treatment Outcome
Khirurgicheskoe lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskoi etiologii.