Results of surgical treatment of patients with critical limb ischemia and analysis of factors affecting patency arterial reconstruction
Keywords:
critical limb ischemia, atherosclerosis, vascular markers, operations on the vessels of the lower extremities, profundoplastyAbstract
Introduction. The growing trend in the number of patients with coronary artery disease of the lower extremities and poor treatment results prompts the scientific community to search for new opportunities for prevention, early diagnosis, and effective treatment of this disease. A separate group consists of patients with critical limb ischemia (CLI), in whom the outcome of surgical treatment is influenced by many factors: age, diabetes, genetic factors, multisegmental atherosclerotic lesions. Despite the various modifications of angiosurgical reconstructions and the progressive development of endovascular technologies, the number of amputations of NC has not significantly decreased. The goal of the work. In a group of patients with critical ischemia, risk factors that may have an impact on reducing the effectiveness of surgical treatment should be studied. Materials and methods. The results of surgical treatment of 60 patients with CINC who underwent arterial reconstruction from 2017 to 2021 were analyzed. Among the laboratory methods of examination, the concentration of fibrinogen, PT%, CD62P, Sirt 1, Sirt 6, IL6, IL-8, PLA2, PCSK9 was studied in all patients. The results. Among concomitant diseases associated with vascular pathology, arterial hypertension was observed in 81.7%, coronary artery disease in 58.3%, and diabetes mellitus was detected in 38.3%. In the analysis of laboratory parameters, a pronounced statistical dependence of fibrinogen in relation to PCSK9 and a statistical dependence of fibrinogen, PCSK9 to CD62P were noted. As for the choice of the method of surgical revascularization in patients with KINK, 36.7% underwent deep fundoplasty, 31.6% underwent femoral-knee shunting, and 15% underwent hybrid intervention. Conclusions. Timely arterial reconstruction in patients with critical ischemia allows to preserve the limb and promotes effective healing of the ischemic wound. The results of the laboratory analysis showed a statistical relationship between PCSK9, fibrinogen and CD62P, which indicates the importance of identifying thrombosis predisposition factors and hemostasis activation markers. The obtained data can contribute to individual risk stratification of possible postoperative complications, namely, optimization of preoperative and perioperative management of patients with critical ischemia of the lower extremities.
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