Multidisciplinary approach to treatment of patients with lower limb critical ischaemia

Maksimov A.V., Koreiba K.A., Nuretdinov R.M, Usmanov M.A., Glinkin V.V.

Chair of Cardiology and Angiology, Republican Clinical Hospital of the Public Health Ministry of the Republic of Tatarstan, Kazan Medical Academy, Municipal Clinical Hospital № 5, Centre "Diabetic Foot", Chair of General Surgery, Kazan State Medical University, Kazan, Russia

Analysed herein are the results of the joint work of the Pyoseptic Surgery Department of the Centre "Diabetic Foot" with the Vascular Surgery Department based in various clinics over 2 periods – 2010 and 2011. During the first period, a total of 126 patients with critical ischaemia were treated without using revascularizing methods, during the second period, a total of 205 patients with critical ischaemia were examined by vascular surgeons deciding upon the problem concerning possibility of revascularization. In 148 cases (72.2%) revascularization was regarded impossible due to pronounced trophic disorders and/or severity of the general somatic status. Fifty-seven patients were subjected to angiography. Of these, five patients were found to have contraindications to vascular reconstruction, with the remaining 52 patients being subjected thereto (65 operations, of which 22 roentgen-endovascular ones). One (1.9%) patient died. Clinical improvement was achieved in 47 (90.3%) cases, and with no dynamics in four (7.7%) subjects.

Using a multidisciplinary approach resulted in a decrease in the incidence rate of high amputations in patients with lower limb chronic ischaemia at the department of Pyoseptic Surgery from 51.6% in 2010 to 35.4% in 2011 (p=0.0000). Of these, the number of the above-the-knee amputations decreased from 41.3% to 15.1%, respectively (p=0.0000). The proportion of crural amputations increased from 20.0% to 46.6% (p=0.04).

KEY WORDS: lower limb critical ischaemia, revascularization, amputations.

P. 126

« Back