Analysis of the results of hybrid arterial reconstructions in the treatment of patients on diabetes mellitus with chronic critical ischemia of the lower extremity

Abstract

The aim of the study. To study and analyze the results of hybrid arterial reconstruction of patients with diabetes with chronic criticalis chemia of the lower extremity. Materials and methods. The results of surgical treatment of 164 patients with diabetes mellitus, type II, chronic critical ischemia of the lower extremity and combined stenotic-occlusive lesion of the superficial femoral artery and arteries of the popliteo–tibial segment were studied. According to the nature of the performed surgery, patients were divided in to a group 1 - 61 patients who under went open reconstruction of the femoral arteries with out intervention on the arteries of the popliteo–tibial segment; a group 2 - 38 patients who underwent an open two-level reconstruction of the arteries; group 3 - 65 patients who underwent hybrid arterial reconstruction. Results of the studies and their discussion. The initial patency of the femoral reconstruction zone in patients of group 1 was 65.6%, secondary - 81.9%, the percentage of high amputations - 18%, mortality - 11.5%. Primary patency of the femoral reconstruction zone in patients of group 2 was 89.5%, secondary - 92.1%, the percentage of high amputations - 5.2%, mortality - 7.9%. Primary patency of the femoral reconstruction zone in patients of group 3 was 81.5%, secondary - 93.9%, the percentage of high amputations - 7.7%, mortality - 4.6%. Conclusion. In patients of group 1, the recovery of superficialfemoralartery patency without intervention on the arteries of the popliteo–tibial segment has unsatisfactory results: the highest mortality rate is 11.5% (significantly different from the mortality in group 2 (p <0.05) and 3 (p <0.001)), the percentage of high amputations - 14.8% (significantly different from the proportion of high amputations in group 2 and 3 (p <0.001)) and by far the worst on the scale of R.B. Rutherford et all. (1997) - 77.1% (p <0.05). The refusal of reconstruction of the arteries of the popliteo–tibial segment significantly worsens the blood supply to the foot and the prospects for healing of ulcerative necrotic lesion and is a provoking factor of thrombosis of the arterial reconstructionzone in the femoral segment. The rates of primary and secondary patency of the arterial reconstructionzone and the proportion of high amputations in patients of groups 2 and 3 are comparable - 89.5 and 81.5%, 94.7 and 96.9% and 2.6 and 3.1%, respectively (p>0 ,05). However, mortality in group 2 was significantly higher than that in group 3 - 7.9% vs. 4.6% (p <0.05). Thus, the hybrid arterial reconstruction method is used as a method of choosing surgical treatment of patients with diabetes mellitus, chronic critical ischemia of the lower extremity due to combined stenotic-occlusive lesion of the superficial femoral artery and arteries of the popliteo–tibial segment, since it shows almost twice lower mortality when compared with other indicators.