SURGICAL PROPHYLAXIS OF THROMBOSIS IN THE ARTERIAL RECONSTRUCTION ZONE IN PATIENTS WITH DIABETES MELLITUS AND THREATENING LOWER LIMB ISCHEMIA

Abstract

Introduction. Arterial disease of the lower extremities usually affects the femoral-popliteal segment and includes a number of clinical manifestations that are associated with a decrease in the patients' functional capacity and their quality of life. Aim. To study the effectiveness and evaluate the results of repeated and thrombotic-preventive operations in diabetic patients with threatening lower limb ischemia and to develop a diagnostic algorithm by clearly structuring the indications for performing operations to prevent thrombosis in the arterial reconstruction zone. Materials and methods. Results of surgical treatment of 110 patients with diabetes mellitus and threatening lower limb ischemia and stenotic-occlusive lesions of the popliteal-tibial segment, who underwent open, endovascular and hybrid reconstructive operations on the arteries of the lower limbs in order to improve blood supply and eliminate the phenomena of threatening lower limb ischemia. Results. The results of operations that prevent thrombosis are significantly (p<0.05) better than the results of repeated operations. Preventive thrombosis operations are aimed not only at preventing thrombosis in the arterial reconstruction zone but also at significantly improving clinical outcomes (p<0.05). Given the significant percentage of amputations after repeated reconstructive operations (25 % after 1 year), we proposed a protocol for examining patients after the primary operation, taking into account the presence of risk factors for systemic obstructive arterial lesions and thrombosis of the arterial circulation and in the inflow and outflow tracts. Conclusions. Thus, preventive surgery, to a much greater extent than repeated surgery, prolongs the time of limb preservation and improves the quality of life of operated patients. Taking into account the risk factors for thrombosis of the arterial reconstruction zone according to the developed algorithm allows for timely examination of patients from the high-risk group and timely raising the question of performing surgical intervention that prevents thrombosis of the arterial reconstruction zone. Based on the developed diagnostic algorithm, indications for performing thrombosis-preventive operations were formulated.

Keywords

• diabetes mellitus
• threatening ischemia of the lower extremities
• endovascular surgery
• hybrid surgery
• reoperation
• thrombosis-preventive surgery