Didenko S. Surgical treatment of chronic critical ischemia of the lower extremities of patients with diabetes mellitus

The work is based on the analysis of the results of surgical treatment of 439 patients with chronic critical ischemia of the lower extremities with diabetes mellitus, type II. Against the background of diabetic microangiopathy in the skin and muscles there was a violation of the proliferation of epidermis cells and intracellular regeneration of myocytes and connective tissue structures, which is associated with a decrease in lumen and a violation of the permeability of the basement membrane of vessels of hemomycocirculatory channel. In patients with severe diabetic microangiopathy, thrombosis after hybrid operation was detected in 7 (22.6%) out of 31 observations. The advantages of performing endovascular intervention in isolated arterial stenotic-occlusive lesions of the arteries of the popliteal-tibial-foot segment and hybrid operation with the combined arterial stenotic-occlusive lesions of the arteries of the popliteal-tibial-foot segment and superficial femoral artery have been proved before open operations. Mortality after open reconstructions is significantly higher than after endovascular intervention - 4.0% vs. 1.3% (p<0.001) and after hybrid operation 7.9% vs. 4.6% (p<0.05). Results of direct revascularization group on probability of healing in 1 and 6 months are significantly better than mediated revascularization group (96.8% and 75.9% (p<0.001) and (98.9% and 86.1% (p<0.05). Results of direct revascularization group and indirect revascularization through collaterals group in 1 and 6 months are comparable (p>0.05). Compliance with the angiosomatic concept for foot revascularization in patients with ischemic form of diabetic foot syndrome significantly improves the probability of healing of ulcerous-necrotic lesions. The developed method of calculation of diabetic microangiopathy index and algorithm of postoperative examination taking into account the risk factors for thrombosis zone of ulcerous-necrotic lesions. The cumulative level of limb preservation after 1 and 3 years after preventive and repeat operation was 98.3% vs. 75.4% (p<0.05) and 91.5% vs. 49.2% (p<0.01).