ANALYSIS OF OUTCOMES OF SURGICAL MANAGEMENT OF PATIENTS PRESENTING WITH ISCHAEMIC-AETIOLOGY PYONECROTIC LESIONS OF LOWER LIMBS

Malakhov Yu.S., Averyanov D.A., Ivanov A.V.
Vascular Surgery Department of the Central Naval Clinical Hospital, State Federal Facility 32nd Central Naval Clinical Hospital, city of Zheleznodorozhnyi,
Moscow Region, Russia

The authors assessed the outcomes of surgical management of eighty-four patients presenting with ulcerative and necrotic lesions of the lower extremities, who were subjected to various reconstructive interventions performed on the major arteries. The duration of the hospital stay in these patients was increased to 23.1±5.6 days. It was determined that in 63.2% of cases, trophic ulcers of the feet had developed on the background of "multi-storey" occlusive and stenotic lesions of the lower-limb major arteries. Trophic alterations in the distal portions of the lower extremities had developed during averagely 3.5±1.6 years following the appearance of the symptoms of intermittent claudication. Destructive changes of the feet in patients with diabetes mellitus and thromboangiitis developed rapidly, were more pronounced, and required performing a postponed operation.

The authors revealed a series of laboratory indices, i.e., blood platelets, stab leukocytes, ESR, as well as the degree of the occlusive lesion of the crural arterial segment, correlating with severity of necrotic changes on the foot. Early thrombosis of the bypasses were caused by unsatisfactory pathways of arterial outflow and a high level of blood haematocrit. The postoperative mortality rate amounted to 4 %, that after six months – to 5%, after one year – to 5 %, and after two years – to 8%. The limb salvation rate immediately after surgery amounted to 98.8%, equalling 92.1% after six months, 92.1% after one year, and 88.9% after two years. The purpose of present work consisted in analysing the outcomes of treatment and determining the factors influencing the limb salvation rate in patients presenting with stage IV ischaemia of the lower extremities.

KEY WORDS: critical ischaemia, ulcerative and necrotic lesions.

P. 133-137

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