CHRONIC CRITICAL UPPER LIMB ISCHEMIA

D.D. Sultanov, A.D. Gaibov, U.A. Kurbanov, Sh.Kh. Saidov, M.R. Tabarov
Chair of Hospital Surgery, Tadjik State Medical University,
Republican Centre of Cardiovascular and Pulmonary Surgery,
Dushanbe, Tadjikistan

Analysis is made of the results of examination and surgical treatment of 70 patients with chronic critical upper limb ischemia. The etiology of damage was atherosclerosis – 13 (18.5%) patients, nonspecific aortoarteritis – 5 (7.1%), Raynaud's disease – 6 (8.6%), thrombangitis obliterans – 7 (10%), postembolic occlusion – 2 (2.8%) patients. Thirteen (18.5%) patients presented with complicated forms of extravasal compression of at its outlet from the chest and 24 (37.2%).patients had sequelae of arterial injuries. On the whole the incidence of critical ischemia constituted 48.8%. In proximal lesions, it accounted for 33%, in lesions of the median level for 47.5%, and in distal lesions, for 50%. Among patients with extravasal compression of the vasculoneurvons band, the incidence of critical ischemia constituted 23%. Based on the study of collateral circulation the key collateral vessels were identified: the deep brachial artery, recurrent collateral arteries in the area of the ulnar flexion and palmar arches of the hand. Factors that favour circulatory decompensation were established: extended occlusions of the distal portion of the subclavian artery, occlusions at the level of the deep brachial artery in combination with lesion of the axillary artery; bifurcation of the brachial artery; occlusions of both arteries of the forearm; obliteration of the arterial arches of the hand and digital arteries; multi-stage occlusions. The indications were elaborated for use of reconstructive and non-standeard methods of revascularization as dependent on the level of lesion. All 70 patients underwent 84 operations. After operation bypass thrombosis was recorded in (7.7%) cases; one (1.2%) patient showed no effect; three (3.6%) patients underwent amputation of the upper limb; the lethality accounted for 1.2%. In the short-term postoperative period, good results were noted in 91.6%, in the long-term period, in 88% of patients.

KEY WORDS: chronic upper limb ischemia.

P. 20-21

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