Zarudnyi O. Optimization of surgical treatment of acute lower limb ischemia based on the severity of reperfusion syndrome

The dissertation presents the results of a study of 215 patients with acute lower extremities ischemia of a thrombotic and embolic nature, who underwent open surgical interventions to restore blood flow. According to the results of the retrospective part of the study, were revealed unfavorable prognostic factors of development of disorders in the functioning of vital organs in the postoperative period, which are associated with reperfusion injuries. The role of clinical and biochemical predictors to the forecasting of an unfavorable course of the reperfusion period was evaluated by using the method of discriminant analysis and a prognostic scale was developed based on the received coefficients. The predictive model allows with 72,4% accuracy to identify the category of patients for whom traditional therapy is not enough to prevent systemic reperfusion injuries. A new comprehensive approach has been developed in the treatment of acute ischemia of the lower extremities for patients with high risk of reperfusion syndrome development, including open thrombectomy, intraoperative modified guided reperfusion, minimally invasive fasciotomy and hemodialysis. In the prospective part of the study, the effectiveness of the proposed comprehensive approach in the prevention of systemic and local reperfusion complications was proved. The possibility of using low-traumatic fasciotomy in patients with severe acute ischemia in combination with intraoperative modified controlled reperfusion has been proven. The use of an comprehensive approach in patients with embolism of the femoral and iliac arteries and acute lower extremities ischemia IIB-IIIA (according to V.S.Saveliev) made it possible to reduce the incidence of acute renal failure from 51,7% to 15,8% (p <0.05), reduce the incidence of cardiovascular and pulmonary complications from 37,9% to 10,5% (p <0.05), reduced the healing time of fasciotomy wounds from 18 to 11 days (p <0.05).