Axiloofemoral Prosthesis in Treatment of Critical Ischemia of the Lower Extremities at Patients with Predicted Short Life Expectancy

Abstract


The purpose of the study The assessment of the efficiency of the method of axillofemoral prosthesis, which was developed in a clinic, for the treatment of patients with predicted short life time. Materials and methods The analysis of complex examination and treatment of 56 patients with critical ischemia of lower limbs, based on bilateral lesions of aorto-iliac segment of atherosclerotic etiology, was carried out. The patients were divided into 2 groups. The control group included 21 patients, the typical axillofemoral alloprosthesis was made for them. The main group consisted of 35 patients for whom the axillofemoral alloprosthesis of an original way with the imposition of the proximal anastomosis between an axillary artery and an artificial limb "end to end" was made. The diagnostic program included reovasography, Doppler sonography, photoplethysmography, scanning of the upper and lower limbs, heart and a shunt for an indentification of blood flow and magistral blood flow type, the level of microcirculation, occlusive - stenotic lesions of arteries, cardiac hemodynamics, the blood flow with the help of shunt after the surgery. Results and their discussion All Patients had severe concomitant diseases in an decompensation stage with the fraction of left ventricular ejection less than 40%. The use of original treatment technology allows in an immediate postoperative period to increase the volume blood flow through the shunt in 2 times, to reduce the number of postoperative complications in 1.6 times. In the postoperative period the average term of shunt functioning increases in 3 times, the clinical status rises on 19.5%, the physical health component - 12.8%, and the mental component - 9.1% and the lethality is reduced in 2.5 times in comparison with the control group of patients. There was no one patient of the main and control groups with complaints of undue fatiguability of upper limbs, where blood flow was switched to the ischemic lower limb. Conclusion The developed method improves the hemodynamic characteristics of blood flow of the proximal anastomosis and simplifies the imposition of the proximal anastomosis between the axillary artery and the artificial limb.

Kursk State Medical University, Kursk, Russian Federation;
Kursk Clinical Emergency Hospital, Kursk, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
Doctor of Medicine, Professor, the head of the department of General Surgery Kursk State Medical University; e-mail: SukovatykhBS@ kursksmu.net

Kursk State Medical University, Kursk, Russian Federation;
Kursk Clinical Emergency Hospital, Kursk, Russian Federation

Email: author@vestnik-surgery.com
Doctor of Medicine, the head of the department of Vascular Surgery, Regional Budget Health Care Facility “Kursk City Clinical Hospital of Emergency Medical Service”, Kursk

Kursk State Medical University, Kursk, Russian Federation;
Kursk Clinical Emergency Hospital, Kursk, Russian Federation

Email: author@vestnik-surgery.com
the candidate of Medical Science, an ordinator of the department of Vascular Surgery, Regional Budget Health Care Facility “Kursk City Clinical Hospital of Emergency Medical Service”, Kursk

Kursk State Medical University, Kursk, Russian Federation;
Kursk Clinical Emergency Hospital, Kursk, Russian Federation

Email: author@vestnik-surgery.com
a postgraduate of the department of General Surgery, Kursk State Medical University

  1. Lemenev V.L. Shuntirovanie s udalennyh sosudistogo lozha
  2. pri lechenii kriticheskoj ishemii nizhnih konechnostej u bol'nyh
  3. srednego i pozhilogo vozrasta [Bypass surgery from remote vascular beds
  4. in the treatment of critical limb ischemia in patients with
  5. middle and old age]. Khirurgiia, 2003; 12: 27-33. - (In
  6. Russian)
  7. Pokrovskii A.V. Klinicheskaia angiologiia: rukovodstvo
  8. dlia vrachei v 2 tomakh pod redaktsiei A.V. Pokrovskogo
  9. [Clinical Angiology: a guide for doctors in two volumes,
  10. edited by A.V. Pokrovskogo]. Moscow, Meditsina Publ.,
  11. , 804 p. - (In Russian)
  12. Rossijskij konsensus "Rekomenduemye standarty dlya ocenki
  13. rezul'taty lecheniya bol'nyh s hronicheskoj ishemiej
  14. nizhnie konechnosti ". [Russian consensus "Recommended standards for assessing
  15. the results of treatment of patients with chronic ischemia of
  16. the lower limbs"]. Moscow, Meditsina Publ., 2001. 29 p. - (In
  17. Russian)
  18. Savel'ev V.S., Koshkin V.M. Kriticheskaia ishemiia
  19. nizhnikh konechnostei [Critical limb ischemia]. Moscow,
  20. Meditsina Publ., 1997, 160 p. - (In Russian)
  21. Ascer E, Veith FJ. Sravnenie ofaxillounifemoral i
  22. axillobifemoral operacii perepuska [Comparison ofaxillounifemoral and
  23. axillobifemoral bypass operations]. Surgery, 1985; 97: 169-
  24. Christine J. Olson. Povtorit' podmyshechno-bedrennyj privivka, kak
  25. Lechenie podmyshechno-bedrennyj okklyuzii transplantata [Repeat axillofemoral grafting as
  26. treatment for axillofemoral graft occlusion]. Archives of
  27. surgery, 2002; 37: 12: 1364-1368.
  28. Martin D., Katz S.G. Podmyshechno-bedrennyj anastomoz dlya aortopodvzdoshnaya
  29. obliteriruyushchij ehndarteriit [Axillofemoral bypass for aortoiliac
  30. occlusive disease]. Am. J. Vasc. Surg., 2000; 180: 100-105.
  31. Mohan C.R., Sharp W.J. Sravnitel'naya ocenka
  32. vneshne podderzhival politetraftorehtilena
  33. axillobifemoral i axillobifemoral shuntirovaniya [A comparative evaluation
  34. of externally supported polytetrafluoroethylene
  35. axillobifemoral and axillounifemoral bypass grafs]. J. Vasc.
  36. Surg., 1995; 21: 801-806.
  37. Passman M.A., Taylor L.M. Sravnenie podmyshechno-bedrennyj
  38. i aortobedrennogo bajpas dlya aortopodvzdoshnaya okklyuzionnoj bolezni [ Comparison of axillofemoral
  39. and aortofemoral bypass for aortoiliac occlusive disease]. J.
  40. Vasc. Surg, 1996; 23: 263-267.
  41. Seeger J.M., Pretus H.A., i dr. Dolgosrochnyj rezul'tat posle togo, kak
  42. Lechenie aortal'nogo infekcii transplantata s postavil extraanatomic
  43. shuntirovanie i aortal'nyj udaleniya transplantata [Long-term outcome after
  44. treatment of aortic graft infection with staged extraanatomic
  45. bypass grafting and aortic graft removal]. J. Vasc. Surg.,
  46. ; 32: 451-454.
  47. Ware J.E., Sherbourne C.D. MOS 36 punktov korotkaya forma
  48. obsledovaniya sostoyaniya zdorov'ya (SF-36): konceptual'naya osnova i punkt
  49. vybor [The MOS 36-item short form
  50. health survey (SF-36): conceptual framework and item
  51. selection]. Med. Care, 1992; 30: 473-483.
  52. Yeager R.A., Taylor L.M. Uluchshennye rezul'taty s
  53. obychnoe upravlenie infrarenal'nogo aorty infekcii [ Improved results with
  54. conventional management of infrarenal aortic infection]. J.
  55. Vasc. Surg., 1999; 30: 76-79

Views

Abstract - 100

PDF (Russian) - 278

PlumX

Dimensions


Copyright (c) 2013 ., ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies