On the basis of complex studies, there was deepened the pathogenesis conception of chronic critical ischemia of the lower extremities (CCILE). It was established that the development of CCILE was underlain by a number of mechanisms, which triggered the transition of ischemic tissues to anaerobic glycolysis, pathological systemic inflammatory process, respiratory hypoxia, where a crucial role belonged to the disordered venous hemodynamics. Along with widely spread (87.2%), concurrent multifocal atherosclerosis (MA), the pathological processes studied play a leading role in unsatisfactory results of the surgical treatment for CCILE. Therefore, we started to solve the problem of diagnosis and treatment for CCILE associated with MA from a proposition of own novel MA classification and the development of new diagnostic methods and algorithms. These allowed us to improve the identification of concomitant atherosclerotic lesions in three basins from 6.9 to 32.7%, those in four basins from 1,7 to 9,4%, and those in five and more basins from 0.3 to 3.4% (Р<0.001 for each comparison). A use of the proposed algorithm for preoperative preparation, which takes into account pathogenetic features of the disease course, allowed us to reduce the number of primary amputations of the lower extremities from 10.2 to 4.2% (P<0.001). Similarly, a use of the proposed methods for revascularization of the lower extremities allowed the number of secondary amputations to be reduced from 37.7 to 12.7% (P<0.001). The original methods were developed for the reconstruction of vascular bed in concurrently damaged arterial basins and used in 153 (30%) patients of the basic group. Owing to them, postoperative mortality was reduced from 5.2 to 2.6% in the immediate period, from 6.5 to 1.4% in the short-term period, from 14.6 to 5.4% in the intermediate period, and from 15.1 to 3.5% in the long-term period (P<0.001 vs. control for each period).A comparison between the proposed medical technologies for CCILE diagnosis and surgical treatment and the methods, which were used traditionally in the treatment for this pathology, showed the former to be more efficacious, safe and convenient. The proposed complex approach to solution of the problem of diagnosis and treatment for CCILE associated with MA ensures good and satisfactory results in 95.8% in the immediate period, 89.7% in the short-term period, 95.6% in the intermediate period, and 90.0% in the long-term period among the patients operated on (P<0.05 vs. control for each period).
