Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 1

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.1.68   |  

I.I. KATELNITSKIY, IG.I. KATELNITSKIY

THE IMPACT OF TYPE AND VOLUME OF BLOOD FLOW RESTORATION ON LONG-TERM SURGICAL TREATMENT RESULTS IN PATIENTS WITH OBLITERATING ATHEROSCLEROSIS IN STAGE OF CHRONIC CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

SBEE HPE "Rostov State Medical University"
The Russian Federation

Objectives. To assess the long-term revascularization results depending on the volume, type of reconstructive interventions as well as the achieved degree of the blood flow compensation as a result.
Methods. Operative treatment results of 157 patients with atherosclerotic occlusions of the lower extremities arteries have been analyzed. Patients were subdivided into 2 groups. Open interventions on the iliac-femoral-popliteal region without blood flow correction along the shin vessels were done in the 1st group (66 patients). Shin revascularization using the combined or hybrid techniques was carried out in the 2nd group (91 patients). The long-term results were followed in terms up to 5 years.
Morphological and functional changes of the blood cells flowing from the ischemic extremities as well as their regress depending on the volume of the blood flow restoration were studied in 57 patients.
Results. A positive result immediately after the operation was obtained in 56,1% of patients of the 1st group and in 62,9% of patients of the 2nd group. The same percentage of positive outcomes was registered immediately after the surgery in the 1st group in (63,1%) and in (63,1%) in the 2nd group, thus a significant prevalence of positive results (29,5%) in the 2nd group of patients compared with the 1st group (16,7%) has been detected. Negative results in the patients of the 2nd group made up 13,1%, it was lower than in the patients of the 1st group (20,2%). Within the whole period 73,23% cases of thrombosis were registered in the 1st group and in the 2nd group they occurred reliably seldom 58,76%.
At electronic microscopy the rough changes of the structure and function of blood cells were revealed that testify to thrombus formation tendency correcting by the blood flow disturbance degree.
Conclusions. While using the combination of open and X-ray-endovascular methods of revascularization the better results were obtained in short- and long-term terms. Severe disturbances of the blood cell composition were registered in patients with obliterating atherosclerosis. Disturbance regress was more evident in the blood flow restoration on all affected portion of the extremity arterial system.

Keywords: obliterating atherosclerosis, critical ischemia, operative treatment, revascularization, hybrid intervention, morphology of blood cells
p. 68 - 74 of the original issue
References
  1. Carruthers TN, Farber A. Current state of affairs in the treatment of infrainguinal critical limb ischemia. Angiol Sosud Khir. 2013;19(2):133-7, 129-33.
  2. Nemkov AS, Kobak AE, Lembrikov IA, Batalin IV, Belyi SA, Lukashenko VI, Senchik IIu. Uspeshnaia simul'tannaia operatsiia u bol'nogo s mul'tifokal'nym aterosklerozom [Successful simultaneous operations in a patient with multifocal atherosclerosis]. Vestn Khir im II Grekova. 2011;170(4):105106.
  3. Gavrilenko AV, Egorov AA, Kotov AE, Molokopoi SN, Mamukhov AS. Metody khirurgicheskogo lecheniia bol'nykh obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei s porazheniem distal'nogo rusla (chast' II) [Surgical treatment of patients with obliterating diseases of the arteries of the lower extremities with a lesion of the distal bed (Part II)]. Angiol Sosud Khir. 2011;17(4):11520.
  4. Gavrilenko AV, Voronov DA, Kochetov SV. Prognozirovanie rezul'tatov arterial'nykh rekonstruktsii i veroiatnosti progressirovaniia ateroskleroza na osnovanii urovnia plazmennykh tsitokinov [Predicting the results of arterial reconstruction and the likelihood of progression of atherosclerosis based on the level of plasma cytokines]. Angiol Sosud Khir. 2010;16(3):146-51.
  5. Uchkin IG, Shugushev ZKh, Talov NA, Bagdasarian AG, Gonsales AK, Khmyrova AV. Opyt primeneniia gibridnykh metodik khirurgicheskogo lecheniia patsientov s kriticheskoi ishemiei nizhnikh konechnostei [The trial of the use of hybrid methods of surgical treatment of patients with critical ischemia of the lower limbs]. Angiol Sosud Khir. 2013;19(2):4857.
  6. Pityk OI, Prasol VA, Boiko VV. Vybor metoda revaskuliarizatsii u patsientov s kriticheskoi ishemiei nizhnikh konechnostei [Select method revascularization in patients with critical lower limb ischemia]. Klin Khirurgiia. 2013 Apr;(4):48-51.
  7. Shval'b PG, Kalinin RE. Antioksidantnaia zashchita i funktsional'noe sostoianie endoteliia u bol'nykh obliteriruiushchim aterosklerozolm arterii nizhnikh konechnostei do i posle operativnogo lecheniia [Antioxidant protection and endothelial function in patients with obliterating atherosclerosis of the lower limbs before and after surgery]. Khirurgiia. Zhurn im NI Pirogova. 2009;(1):5355.
  8. Vita JA, Hamburg NM. Does endothelial dysfunction contribute to the clinical status of patients with peripheral arterial disease? Can J Cardiol. 2010 Mar;26 Suppl A:45A-50A.
  9. De Haro Miralles J., Martinez-Aguilar E., Florez A., Varela C., Bleda S., Acin F. Nitric oxide: link between endothelial dysfunction and inflammation in patients with peripheral arterial disease of the lower limbs. Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):10712.
  10. Davies PF, Civelek M. Endoplasmic reticulum stress, redox, and a proinflammatory environment in athero-susceptible endothelium in vivo at sites of complex hemodynamic shear stress. Antioxid Redox Signal. 2011 Sep 1;15(5):1427-32.
  11. Weis-Muller BT, Rommler V, Lippelt I, Porath M, Godehardt E, Balzer K, Sandmann W. Critical chronic peripheral arterial disease: does outcome justify crural or pedal bypass surgery in patients with advanced age or with comorbidities? Ann Vasc Surg. 2011 Aug;25(6):783-95.
  12. Ohno T, Kaneda H., Nagai Y, Fukushima M. Regenerative medicine in critical limb ischemia. J Atheroscler Thromb. 2012;19(10):883-9.
  13. Pokrovskii AV. Klinicheskaia angiologiia [Clinical angiology]: prakt ruk: v 2 t. Moscow, RF: Meditsina; 2004;2. 878 p.
Address for correspondence:
344000, Rossiiskaia Federatsiia, g. Rostov-na-Donu, per. Nakhichevanskii, d. 29, GBOU VPO Rostovskii gosudarstvennyi meditsinskii universitet, kafedra khirurgicheskikh boleznei 1,
e-mail: katelnizkji@mail.ru,
Katelnitskiy Igor Ivanovich
Information about the authors:
Katelnitskiy I.I. MD, professor, a head of the chair of surgical diseases N1 SBEE HPE
"Rostov State Medical University" Public Health Ministry of Russian Federation
Katelnitskiy Ig.I. PhD, an accosiate profesor of the chair of surgical diseases N1 SBEE HPE
"Rostov State Medical University" Public Health Ministry of Russian Federation
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