Koval B. Diagnosis and surgical treatment for chronic critical ischemia of the lower extremities associated with type 2 diabetes mellitus

The work deals with the problem of diagnosis and choice of surgical treatment of patients with chronic critical ischemia of lower extremities associated with type 2 diabetes mellitus. Research based on the results of examination and surgical treat-ment of 254 patients with atherosclerotic lesions of arteries and occlusion of aorto-femoral-popliteal-ankle segment. Based on the results developed medical diagnostic algorithm with use of the doppler ultrasound, laser doppler floumetry, electroneuro-myographyof lower extremities, which allowed the tactic to optimize treatment and to identify ischemic and neyroishemic types of lower extremities in patients with critical ischemia, select the types of angiographic lesions arteries ankle segment that must be considered when choosing the optimal type of surgical intervention. It is proved that the main factor determining the possibility of shunt surgery for occlusion of the fem-oral-popliteal-ankle artery segment, there is adequate blood outflow tract, size of an index of peripheral vascular resistance less than 4 and the functional capacity of the arterial arch foot. Studied the immediate and long-term results of surgical treatment. Implementation of the developed tactics of treatment in clinical practice possible to achieve better blood supply to the lower extremities in direct (89,0%) and in remote periods in 73,0% (P <0,01) patients