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Khirurgii

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Year 2013 Vol. 21 No 5

GENERAL AND SPECIAL SURGERY

O.I. MIMINOSHVILI1,2 , V.N. PSHENICHNYY1,2, Y.V. RODIN1, V.Y. VESELY2, Y.V. BISTROVA2, A.O. KOVALCHUK1

PREDICTING THE OUTCOME OF INFRAINGUINAL REVASCULARIZATION IN CRITICAL LIMB ISCHEMIA ACCORDING TO TRANSCUTANEOUS OXIMETRY

SE "Institute of Emergency and Restorative Surgery named after V.K.Gusak", Donetsk1 ,
Donetsk National Medical University named after M.Gorky2
The Ukraine

Objectives. To elaborate the prognostic criteria of infrainguinal reconstructive surgeries in patients with the lower limb critical ischemia using functional tests at transcutaneous oximetry.
Methods. 75 patients with atherosclerotic artery occlusions in the femoral-popliteal segment were engaged into the research. Two-level arterial reconstructions were performed in 19 cases, infrainguinal reconstructions – in 37 and lumbar sympathectomy – in 19. In the preoperative period all patients underwent transcutaneous oximetry using the apparatus “Radiometer” (Denmark) with positional functional test.
Results. It has been revealed that in 88% of patients the lower limbs chronic critical ischemia was caused by the combined affection of several arterial segments including aorthal-inguinal, femoral-popliteal and tibial-pedal segments in various combinations. 70% of the operated patients has not received distinct angiographic information about the state of both dorsal and plantar arterial arch of the foot.
The favorable operative result has been attained in 40 cases. In 35 patients positive clinical and haemodinamic effect hasn’t been reached. The initial basal transcutaneous oxygen pressure (tcPo2) in the skin of the operated patients with favorable and unfavorable postoperative results has not significantly differed (7,4±2,6 vs 8,2±1,4, p=0,2). The value of orthostatic Po2 Hg growth more than 20 mm Hg permitted to predict reliably the favorable outcomes of the infrainguinal reconstructions (ð=0,001), lumbar sympathectomy (ð=0,01), but it appeared to be inadequate in two-level arterial reconstructions of the aorthal-inguinal and femoral-popliteal lower limb segments (ð=0,1). According to the orthostatic test of transcutaneous oximetry the negative prediction of surgical treatment turned out to be true in 84,4% of the operated patients and positive prediction – in 87,5 %.
Conclusions. The microcirculation analysis by means of transcutaneous oximetry allows predicting the treatment outcome and thus to choose the optimal method of the critical limb ischemia.

Keywords: chronic critical limb ischemia, reconstructive surgery, transcutaneous oximetry, prediction
p. 45 – 49 of the original issue
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Address for correspondence:
83045, Ukraina, g. Donetsk, Leninskii pr., d. 47, Donetskii gosudarstvennyi meditsinskii universitet, kafedra khirurgii im. V.M. Bogoslavskogo,
e-mail: choice@online.ua,
Pshenichnyi Vladimir Nikolaevich
Information about the authors:
Miminoshvili O.I. MD, professor, a head of the department of surgery named after V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky, deputy director of the SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Pshenichnyy V.N. PhD, An associate professor of surgery named after V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky, deputy director of the SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Rodin Y.V. MD, a head of the chair of vascular surgery of SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Vesely V.Y. PhD, associate professor of the chair of surgery named by V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky.
Bistrova Y.V. An assistant of the chair of Infectious diseases of Donetsk National Medical University named after M. Gorky.
Kovalchuk A.O. A cardiovascular surgeon of SE “Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
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