Defeat of the hemomycocirculatory bed in patients with diabetes mellitus with critical ischemia of the lower limb

Abstract

The aim of the study. To develop the method of calculation of the index of degree of diabetic microangiopathy on the basis of determining the quantitative characteristics of damage to the hemomycocirculatory skin of the skin in patients with diabetes mellitus with critical ischemia of the lower limb. Material and methods. Samples of paraffin blocks of skin of 63 patients (experimental group) on diabetes mellitus, type II with chronic critical ischemia of the lower limb, on the background of combined stenotic-occlusive lesions of the arteries of the femoral and pediculophagomic segments, in combination with ulcerative-necrotic footlesions, who were treated at the Center for Vascular Surgery at the Clinical Hospital "FEOPHANIA" of the State Department of Affairs during 2013 – 2017 were selected. A comparison group selected samples of skin and muscles of 30 patients who didnot have systemic diseases. Histologic and immunohistochemical studies were conducted to detect collagen IV – marker of basal membranes, VEGF – vascular endothelialgermfactor; CD 31 - endothelialfactor; smooth muscle actin. Measured and compared the diameter of the blood vessels of the hemomycrocirculatory channel of skin of and muscle and the density of the capillaries. On the basis of the obtained data, the calculation of the degree of diabetic microangiopathy was performed. Results of the studies and their discussion. Characteristic changes were observed in the morphometric indices of blood vessels in the hemomycocirculatory channel of the skin in patients with diabetes mellitus, type II with chronic critical ischemia of the lower limb. The method of calculating the degree of diabetic microangiopathy is developed. The correlation between the degree of diabetic microangiopathy and the probability of thrombosis after hybrid arterial reconstruction is revealed, and the algorithm of patient examination in the postoperative period is developed. Conclusions. 1. The collection of data on qualitative and quantitative changes in the hemomycocirculatory channel of the skin allowed to develop criteria for the calculation of the degree of diabetic microangiopathy.  2. The rewas a correlation between the severity of diabetic microangiopathy and the probability of thrombosis after hybrid arterial reconstruction. 3. Determination of severity of diabetic microangiopathy can be used in the creation of a survey algorithm to identify in dications forpreventive operations that prevent thrombosis of the arterial reconstructionarea and the nature of conservative treatment after arterial reconstruction in patients with diabetes with chronic critical ischemia of the lower limb.