Orlov A. Optimization of surgical correction of the upper extremity acral ischemia

Thesis for a candidate of the medical science degree in specialty of 14.01.03 "Surgery". - Kharkiv medical academy of postgraduate education of the Ministry of Health of Ukraine, Kharkiv, 2020. The thesis presents a theoretical framework and a solution of the current problem of modern vascular surgery - increasing the effectiveness of the treatment of patients with obliterative diseases of the upper extremities by studying the short-term and long-term results of thoracoscopic and digital sympathectomy taking into account the data of the ultrasonic research method of the treatment of patients with acral ischemia of the upper extremities. The work is based on a retrospective analysis of the results of treatment of 133 patients with upper extremity acral ischemia. The analysis of results of the surgical treatment of patients with upper extremity acral ischemia in the short-term and long-term depending on the chosen method of treatment and the degree of ischemia of the upper extremities and a comparative analysis of thoracoscopic and digital periarterial sympathectomy based on the dynamics of VEGF, nitric oxide and endothelin-1 was carried out. The dynamics of Willebrand factor, tissue plasminogen activator and transforming growth factor-1 in different methods of surgical treatment. It is established that thoracoscopic and digital sympathectomy are effective surgical interventions. It was found that digital sympathectomy in atherosclerosis obliterans according to the dynamics of vascular growth factors does not eliminate limb ischemia, and moreover - intensifies it for up to 14 days. This confirms the fact of contraindications to this surgery for patients with atherosclerosis obliterans with III - IV degree of upper extremity ischemia. It was proved that the results of the digital sympathectomy in comparison with thoracoscopic had the greatest positive effect for patients with Raynaud's syndrome, the least for patients with atherosclerosis obliterans. Based on the study of clinical efficacy, number and level of limb amputations, it is proved that for patients with upper extremity acral ischemia on the background of atherosclerosis obliterans, thoracoscopic sympathectomy and digital periarterial sympathectomy are ineffective and can only be used as in critical cases for young patients. Key words: upper extremity acral ischemia, sympathectomy, vascular growth factor.