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Year 2019 Vol. 27 No 6

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

S.N. EROSHKIN 1, L.A. FRALOU 1, Y.I. RATOMSKI 2, S.P. BABKOV 3, K.G. TSYPLAKOV 4, K.O. CHEPIK 1

EFFICACY OF PERIPHERAL ARTERY DISEASE TREATMENT BY CRUS TUNNELING IN COMBINATION WITH BONE MARROW TRANSPLANTATION DEPENDING ON THE SEVERITY OF LOWER LIMB ISCHEMIA

Vitebsk State Medical University1,
Vitebsk Central City Clinical Hospital2,
Vitebsk Regional Clinical Hospital3,
Vitebsk Regional Clinical Specialized Centre4, Vitebsk,
The Republic of Belarus

Objective. To determine the effect of bone marrow auto transplantation combined with the limb soft tissues tunneling in treatment of peripheral artery disease depending on the grade of chronic limb ischemia.
Methods. 62 men with peripheral artery disease of the lower limbs were included in the study and they were divided into three groups according to the Pokrovsky-Fontaine classification: the 1st group – IIb (15 patients), the 2nd – III grade (27 patients), the 3rd – IV grade (20 patients). In all patients, bone marrow auto transplantation combined with tunneling of the crus soft tissues was used as method of indirect revascularization. Results were assessed by the amount of amputations in every group, distance increase of painless walking, temperature of the operated limb and ankle-brachial index. The data were collected 6 and 12 months after surgery.
Results. The number of high-level amputations in the third group was more than in the first and the second ones during examinations 6 and 12 months after surgery (p=0.0001). Distance increase of painless walking in the third group was reliably less than in other groups 6 months (p=0.001) and 12 months (p=0.0001) after treatment. Furthermore, during second half year of observation distance of painless walking increased in the first (р=0.011) and the second (р=0.009) groups but it decreased in the third group (р=0.003). Temperature of the operated limb during the second half year of observation had similar dynamics: it increased in the first and second groups but did not change in the third one. Reliable changes of ankle-brachial index were absent in all examined groups 6 and 12 months after
Conclusions. Bone marrow auto transplantation combined with tunneling of the crus soft tissues is more effective in patients with IIb and III grades of limb ischemia and it may be applied in these categories of patients in the case when direct revascularization is impossible.

Keywords: revascularization, critical ischemia, peripheral artery disease, tunneling, bone marrow auto transplantation
p. 622-629 of the original issue
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Address for correspondence:
210027, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
General Surgery Department.
Tel.: +375 33 611-19-75.
e-mail: sergionik2014@gmail.com,
Sergey N. Eroshkin
Information about the authors:
Eroshkin Sergey N., PhD, Associate Professor of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3617-8719
Fralou Leanid A., PhD, Associate Professor, Head of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-3357-4409
Ratomski Yury I., Head of the Surgery Unit, Vitebsk Central City Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-1175-3193
Babkov Siarhei P., Angiosurgeon of the Endovascular Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-6073-4629
Tsyplakov Konstantin G., Head of the Proctology Unit, Vitebsk Regional Clinical Specialized Centre, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-7995-9019
Chepik Kiryl O., Assistant of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-8499-0248
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