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 (р=0,001), lumbar sympathectomy (р=0,01), but it appeared to be inadequate in two-level arterial reconstructions of the aorthal-inguinal and femoral-popliteal lower limb segments (р=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
References
  1. Pokrovskii AV, Dan VN, Chupin AV, Kharazov AF. Mozhno li predskazat' iskhod rekonstruktivnoi operatsii u bol'nykh s ishemiei nizhnikh konechnostei na osnovanii dooperatsionnykh issledovanii? [Is it possible to predict the outcome of reconstructive surgery in patients with lower limb ischemia on the basis of preoperative studies?] Angiol i Sosud Khirurgiia. 2002;8(3):102–09.
  2. Singh N, Sidawy AN, DeZee KJ, Neville RF, Akbari C, Henderson W. Factors associated with early failure of infrainguinal lower extremity arterial bypass. J Vasc Surg. 2008 Mar;47(3):556-61.
  3. Nguyen LL, Conte MS, Menard MT, Gravereaux EC, Chew DK, Donaldson MC, Whittemore AD, Belkin M. Infrainguinal vein bypass graft revision: factors affecting long-term outcome. J Vasc Surg. 2004 Nov;40(5):916-23.
  4. Guz' VS, Sidorov RV. Obosnovanie khirurgicheskogo lecheniia mnogoetazhnykh okkliuzii arterii nizhnikh konechnostei po dannym lazernoi doplerovskoi i intraoperatsionnoi floumetrii [Rationale for the surgical treatment of multi-storey occlusion of arteries of lower extremities according to laser Doppler flowmetry and intraoperative]. Metodologiia floumetrii. Moscow, RF; 1998. p. 41-51.
  5. Ubbink DT, Tulevski II, de Graaff JC, Legemate DA, Jacobs MJ. Optimisation of the non-invasive assessment of critical limb ischaemia requiring invasive treatment. Eur J Vasc Endovasc Surg. 2000 Feb;19(2):131–37.
  6. Kislov EE, Panfilov SD, Zoloev GK, Dedikova TN, Koval' OA. Sravnitel'naia otsenka metodov prognozirovaniia effektivnosti poiasnichnoi simpatektomii u patsientov s kriticheskoi ishemiei nizhnikh konechnostei. [Comparative evaluation of methods for predicting the effectiveness of lumbar sympathectomy in patients with critical ischemia of the lower limbs]. Angiol i Sosud Khirurgiia. 2009;15(1):138–41.
  7. Belov IuV, Sandrikov VA, Kosenkov AN i dr. Khirurgicheskoe lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskoi etiologii [Surgical treatment of patients with chronic critical ischemia of the lower extremity atherosclerotic etiology]. Khirurgiia 1997;(2):45–51.
  8. Gavrilenko AV, Omarzhanov OA, Abramian AV. Mikrotsirkuliatsiia u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei [Microcirculation in patients with chronic lower limb ischemia]. Angiol i Sosud Khirurgiia. 2003;9(2):130–35.
  9. de Graaff JC, Ubbink DT, Legemate DA, Tijssen JG, Jacobs MJ. Evaluation of toe pressure and transcutaneous oxygen measurements in management of chronic critical leg ischemia: a diagnostic randomized clinical trial. J Vasc Surg. 2003 Sep;38(3):528–34.
  10. Faglia E, Clerici G, Caminiti M, Quarantiello A, Curci V, Morabito A. Predictive values of transcutaneous oxygen tension for above-the-ankle amputation in diabetic patients with critical limb ischemia. Eur J Vasc Endovasc Surg. 2007 Jun;33(6):731–36.
  11. Gusak VK, Pshenichnyi VN. Sposob diagnostiki prokhodimosti bertsovo-stopnogo arterial'nogo segmenta [A method of diagnosing of tibia Iambic arterial segment permeability]. Patent na izobretenie - SU 1811372 A3 ot 23.04.93 A61B5/00, G01N33/483 (biul.№15). patentoobladatel': Donets gos med institut im M Gor'kogo.
  12. Kozlov VI, Azizov GA. Patofiziologicheskaia kharakteristika rasstroistv mikrotsirkuliatsii pri khronicheskoi arterial'noi ishemii nizhnikh konechnostei [Pathophysiological characteristics of microcirculation in chronic arterial ischemia of the lower limbs]. Angiol i Sosud Khirurgiia. 2007;1(13):17–23.
  13. Lisin SV, Chadaev AP, Krupatkin AI, Rogov KA, Markov AV, Kozhemiakin SA. Sostoianie mikrotsirkuliatsii pri 4 stadii khronicheskoi arterial'noi nedostatochnosti nizhnikh konechnostei ateroskleroticheskogo geneza [Microcirculation of lower limbs chronic arterial insufficiency ( the 4th stage)of atherosclerotic genesis]. Angiol i Sosud Khirurgiia. 2008;14(1):21–28.
  14. Scheffler A, Eggert S, Rieger H. Influence of clinical findings, positional manoeuvres, and systolic ankle arterial pressure on transcutaneous oxygen tension in peripheral arterial occlusive disease. Eur J Clin Invest. 1992 Jun;22(6):420–26.
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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