Shapovalov D. Substantiation of differentiated application of surgical methods of shin and foot revascularization in patients with diabetes mellitus

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

State registration number


Applicant for


  • 222 - Медицина


Specialized Academic Board

ДФ 26.003.072

Bogomolets National Medical University


In the dissertation work the choice of a technique of revascularization of a shin and foot at patients with a diabetes mellitus on the basis of data of complex inspection is substantiated. The pathological condition considered in the dissertation, ischemic diabetic foot, occurs due to a combination of two severe diseases - diabetes and atherosclerosis of the arteries of the limb. The number of patients with diabetes, according to the WHO report for 2016 in Ukraine is 9.1% and tends to increase, both in Ukraine and around the world. Patients with diabetes are 2.5 times more prone to peripheral artery disease than people of the same age without diabetes. Damage to the arteries of the lower extremities by atherosclerosis in combination with diabetes remains the main cause of non-traumatic amputations of the lower extremities, which significantly impairs the quality of life and leads to disability of people over 50 years. The risk of trophic disorders with foot lesions, of all patients with diabetes is 25% of observations, and according to some studies can reach 34%. According to the International Diabetes Federation, 9.1 million of the world's 26.1 million people suffer from trophic foot ulcers each year. According to scientists from the United States and a number of European countries, large non-traumatic amputations in patients with diabetes are performed in 45-70% of cases. Of these, in the combination of diabetes mellitus and peripheral artery disease, the number of performed amputations reaches 37-47% of cases, without diabetes is 16.2% -22.1%. After major amputations, the average life expectancy of 50% of diabetics is only 2 years, and the 5-year mortality rate is 40-90% of cases. The use of revascularization allows to achieve limb preservation in diabetics with peripheral artery disease for 1 year in 78-85% of cases, and without revascularization in 54%. Rationale for the differentiated use of surgical methods of revascularization (reversible surgery and X-ray endovascular intervention) are presented in TASK-II (2007) on which surgeons relied when choosing a method of revascularization, but the features of atherosclerotic arteries in patients with diabetes mellitus. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC-II). The rapid transition to an increase in the rate of interventions has led to intraoperative and early complications, increased reoperations and unsatisfactory results, especially in patients with diabetes, which has led to a revision of the strategy "most endovascular". The interest in endovascular surgery has been balanced in the ESVS Global Guidelines (2019) for the treatment of chronic ischemia threatening the extremities, but they limit the application of these guidelines to patients with diabetes due to the significant difference between peripheral and peripheral arterial disease and diabetes. foot, which prompted us to continue the research. Therefore, we consider it important to have a differentiated approach to the use of two basic and two derived methods of interventional revascularization. The basic ones include surgical and endovascular revascularization (angioplasty). Derivatives include hybrid revascularization (a combination of X-ray endovascular and surgical techniques within a single procedure), as well as catheter-directed thrombolysis - the use of endovascular techniques for targeted administration of thrombolytic drugs. Aim. To increase the effectiveness of treatment of patients with diabetes mellitus with lesions of the arteries of the lower extremity by improving the diagnostic and treatment algorithm for differentiated application of revascularization techniques. To achieve this goal, a retrospective analysis of surgical revascularizations for the period 2001-2009 was conducted. and X-ray vascular revascularizations performed at DNU for the period 2013-2014. The results of surgical revascularization were considered unsatisfactory due to the large number of failures in revascularization - 36%, this group was selected as the first group of comparison - GC1.


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