Mashura V. Indirect revascularization of the lower extremities in the complex treatment of chronic arterial ischemia in patients with diabetes mellitus.

The results of complex examination and surgical treatment of 124 patients with chronic arterial ischemia on the background of distal occlusive-stenotic lesions of the vessels of the lower extremities in patients with atherosclerosis and diabetes mellitus are studied and analyzed. The isolated revascularizational osteotrepanation (ROT) was performed for 27 patients in group I and 17 in patients in group ІІ; ROT in combination with profundoplasty was performed on 35 patients of group І and 29 of patients of group II; ROT in combination with lumbar sympathectomy was performed in 7 and 9 patients respectively in groups I and II. Study of the long-term results by the Kaplan-Meier estimator, it has been found that among the indirect methods of revascularization in chronic ischemia against the background of atherosclerosis and diabetes, the best result in preserving the limb at a level of 63% and over for three years is given by profundoplasty and revascularization osteotrepanation. Revascularizational osteotrepanation in chronic ischemia as an independent intervention, eliminating pain syndrome, retains the limb for three years in 33,3% of patients with diabetes, with atherosclerosis – 29,4%; in combination with lumbar sympathectomy, only in 28,6% of patients with diabetes and in 33,3% of patients with atherosclerosis, respectively.