Affiliation:
1. SI “Republican Scientific Center of Cardiovascular Surgery” of the Ministry of Healthcare and Social Protection of RT;
SEI Avicenna Tajik State Medical University
2. SI “Republican Scientific Center of Cardiovascular Surgery” of the Ministry of Healthcare and Social Protection of RT
Abstract
Objective. To analyze the immediate results of treatment of patients with acute arterial obstruction of the lower limbs during advanced stages of ischemia.Material and methods. The results of a comprehensive examination and treatment of 244 patients (135 men, 109 women, average age 67,2±8,4 years) with acute arterial obstruction of lower limbs were analyzed. Acute thrombosis was observed in 105 (43,1%) patients and embolism of the main arteries in 139 (56,9%) patients. 197 (80.7%) patients had ischemia of one (102 left, 95 right lower limbs) and 38 (15.6%) of both lower limbs. In 244 patients acute ischemia was noted in a total of 281 lower extremities. 86.9% of patients were hospitalized 24 hours after the onset of the disease. In 190 cases the affected limbs had II degree ischemia (54 cases (19,2%) of IIA degree, 136 (48,4%) IIB degree), and 91 (32,4%) patients had ischemia of III degree.Results and discussion. The main component of the operation for vascular embolism was thromboembolectomy (n=110), which in 56 cases was supplemented by vessel reconstruction (n=13), fasciotomy (n=34), and necrectomy (n=12). Primary amputation of the limb was performed in 13 cases. Conservative angiotropic therapy was performed in 16 cases.In acute thrombosis of lower limb arteries, conservative treatment was performed in 28 cases, primary limb amputation was performed in 10 cases, thrombectomy with a local reconstruction of the vessel (n=31), also with bypass (n=14), with reconstruction and fasciotomy of the tibia (n=13) and with reconstruction and necrectomy (n=7) were performed in 93 cases.Conclusion. Despite the delayed treatment in 67.6% of cases, the acute ischemia presented less severely, suggesting that the level of obstruction is more influential than the timing of the onset in the development of ischemic limb injuries. The choice of treatment method and extent at advanced stages of limb ischemia primarily depends on the degree and severity of ischemic disorders. The outcomes of treatment were less satisfactory in acute arterial thrombosis than in embolism, largely due to chronic obliteration of the distal arterial channel.
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