Gupalo Y. Substantiation of surgical method foot revascularization in diabetic patients.

Distal bypasses are used in the treatment of acute or chronic limb threatening ischemia in order to avoid major amputations.The dissertation is devoted to avoiding of major amputations in patients with necrotic diabetic foot by using of pedal bypass. The developed algorithm of clinical, ultrasonic and angiographic examination has allowed to determine the tactics of treatment of 508 patients with necrotic diabetic foot and select 58 (11.4%) of them for pedal bypass. The anterior tibial artery (a. dorsalis pedis) was selected as outflow artery in 41 (70.7%) cases, posterior tibial artery - in 17 (29.3%).Complex evaluation of obtained haemodinamic data according to ultrasound colour duplex scanning gave an opportunity to determine the main role of high-resistance bloodflow in outflow artery in frequency of occurrence of shunt thrombosis. The sanation of foot necrotic changes was performed before bypass procedure in 5 (8.6%) cases, simultaneously with bypass procedure - in 18 (31.1%), after foot revascularisation - in 35 (60.3%) and depended on the type of foot necrotic changes. Primary healing of foot wounds was achived in 88.5% cases. Limb salvage rates in early postoperative period were 94.2%, during one year - 88.5%, during two years - 55.2%. Nine (15,5%) patients were died with a salvaged limb.