Venous occlusive plethysmography in assessment of hemodynamics in arterial thrombosis of the lower extremities]

With the use of a method of venous occlusive plethysmography changes, in regional arterial and venous hemodynamics in 75 patients with arterial thrombosis as well as in 47 after reconstructive intervention at the immediate period, and in 25--at the late period were studied. It was established that in ischemia progression, the volume blood flow rate at rest and maximum rate decreased, indicating severe impairement in reserve possibilities of blood flow, maximum venous outflow reduced, venous filling of the vessels increased. In thrombosis, rough disorders in reserve possibilities of blood flow in the aorto-iliac segment were noted. After operation, dynamics of the indices didn't depend on type of reconstructive intervention and was determined only by adequacy of blood flow restoration in the extremity.     

Transplantation of allogeneic veins and xenogeneic arteries in the reconstructive surgery of occlusive diseases of arteries of the lower extremities

The article discusses the results of 91 reconstructive operations with the use of allogeneic veins and xenogeneic arteries in the management of occlusive lesions of the arteries of the lower limbs. The method of obtaining and storing the grafts and the operative techniques are described. Patency of the allogeneic and xenogeneic shunts in occlusions of the lower limb arteries was 47% in the long-term follow-up periods.     

Roentgeno-surgical treatment of vascular occlusive diseases of the lower extremities

The methods of direct revascularization of the lower extremities in occlusive-stenotic lesion at the stage of severe ischemia were used in 144 patients. Of them in 35, simultaneously or with a several day interval, the ++roentgeno-endovascular dilatation (RED) in the several segments of the arterial bed was carried out, in 36--RED was performed in combination with 2-3 procedures of plasmapheresis, in 16 patients in occlusion to a large extent, the isolated balloon profundoplasty was performed, in 46 patients with total lesion of the vessels--isolated RED of the aorto-iliac segment. This contributed to increase in the effectiveness of the collateral blood flow in the vessels of the lower extremities. A high effectiveness of the methods employed was noted in follow-up of from 1 to 5 years. The indications for the use of RED and causes of failures are presented.     

Functional cineangiography in the diagnosis of arterial occlusive diseases of the lower extremities

An analysis of cineangiograms of lower extremity arteries of 225 patients with occlusive lesions of the abdominal aorta and lower extremity arteries has been made. Symptoms detected by cineangiography are described which allow to judge on stenotic lesions of the arteries with greater reliability than by the data of serial angiography. Quantitative analysis of cineangiograms has been performed with the determination of time of blood flow along arterial segments.     

Tactics of the surgical treatment of combined occlusive diseases of the coronary arteries, the abdominal aorta and the arteries of the lower extremities]

On the basis of experience in reconstructive operations on 250 patients with combined affection of the coronary arteries, abdominal aorta, and arteries of the lower limbs the authors discuss the diagnostic and tactical features of surgical management of these patients. The article dwells upon the necessary preoperative diagnostic algorithm as well as that in tactical variants of surgical treatment: (1) one-stage reconstructive operations on several vascular beds; (2) successive stage-by-stage treatment of patients with combined vascular pathology; (3) reconstructive vascular intervention on only one of the vascular beds. Correct practical solution of all these problems allowed the authors to reduce postoperative lethality to 5.4% among this grave contingent of patients with combined vascular pathology.     

Partial denervation in complex treatment of occlusive diseases of the lower extremity arteries

The interventions efficacy, conducted on a nervous structures in 198 patients for occlusive diseases of the lower extremities arteries, in 68 of whom a femoral and sciatic nerves blockade were performed together with epidural anesthesia and open alcoholizing of sciatic nerve, was estimated. Efficacy of partial denervation in complex treatment of patients, suffering chronic ischemia of the lower extremities stages II - IlIA, was established, when performance of a direct revascularization is impossible because of a secured functional reserve present.     

Ergography of crural muscles in the diagnosis of arterial occlusive diseases of the lower extremities

Under examination there were 280 patients with obliterating diseases of lower extremity arteries using the methods of selective ergometry of musculus gastrocnemius. It was established that initial stages of the disease were characterized by 10-fold decrease of working capacity of leg muscles. With progress of ischemia and longer duration of the disease and simultaneously decreased volume of work the strength of a single muscular contraction dropped, their average and maximum instantaneous power decreased which demonstrates the development of degenerative alterations in muscles. Bilateral lesion of the arteries was diagnosed in 85% of patients with complaints about ischemic pains in one extremity. Selective ergography may be used for diagnosing preclinical forms of the disease and objective evaluation of the results of treatment.     

Use of regional perfusion in the treatment of arterial occlusive diseases of the lower extremities

The work presents an analysis of 120 isolated perfusions performed in 103 patients with obliterating injuries of the peripheral vessels of lower extremities. In 17 patients the perfusion was performed twice. For prophylactics of the commissural process the area of connection of main vessels of the artificial circulation apparatus (ACA) in 56 patients was wrapped up by teflon in order to ease reoperation. Good and satisfactory results were obtained in 79 (76.7%) of the patients which allowed them to return to their working activity. The application of the teflon sleeve at the level of connection of the ACA vessels was found to prevent the commissural process and to facilitate the access to the vessel in a repeated isolated perfusion.