Doctoral thesis is devoted to the diagnosis and endovascular treatment of lower extremities ischemia in patients with diabetes mellitus (DM). At present stage of surgery development, the most optimal methods for diagnostics the state of arterial bed of the lower extremities in patients with occlusive and stenotic atherosclerotic diseases are the use of ultrasound and X-ray angiographic examination methods, and, in relation to the methods of revascularization, there is a consensus on the choice of the surgical treatment method. There is also no specific algorithm for the actions of surgeons, vascular surgeons and endocrinologists who directly make decisions and chooses tactics for the treatment of patients with ischemic type diabetic foot syndrome (DFS); there is no specific route for the patient that would minimize signs of this disease, reduce disability and mortality, taking leading leading position as a result of various complications and signs of DM for the past 20 years. Therefore, improving the diagnosis and endovascular treatment of patients with this pathology, aimed at improving blood circulation in the lower extremities, remains an urgent issue in surgery.
At present time, when performing balloon angioplasty, there are no clear recommendations on the time it takes to reach the nominal pressure in the balloon. We have an understanding that the nominal pressure in the balloon is reached in a minimum period of time is related to the simultaneous acquisition of a given shape by the balloon at such a pressure, and, therefore, there is a sufficient increase in the lumen of the vessel, which leads to mechanical injury of the vascular wall, which may be accompanied by intima ruptures and its detachment. This leads to the occurrence of thrombosis in the postoperative period, and in case of detachment of particles of atherosclerotic plaques – by embolism or thromboembolism of the distal arteries, as a result of which even successfully performed endovascular surgical interventions can result in the loss of a lower extremity and even pose a threat.
At the same time, if to influence the vascular wall by gradually increasing the pressure in the balloon, thereby gradually increasing the lumen of the vessel, the rupture process is replaced by a stretching process. With a decrease in the traumatization of the vascular wall, the number of complications arising from this also decreases.
The aim of this study is to improve the results of treatment of patients with ischemic type diabetic foot syndrome by improving the capabilities of X-ray endovascular methods of diagnostics and treatment.
Based on results of research, an algorithm for the diagnosis and treatment of patients with ischemic type DFS was developed, which provides a route for examining patients with DM who are concerned about pain in the lower extremities that occur at rest and have purulent and necrotic complications of the feet. Considerable attention is devoted to the peculiarities of performing endovascular interventions on popliteal and tibial arteries using staged dosed prolonged balloon angioplasty.
Data on assessment of the quality of life of patients with ischemic type DFS in the period before endovascular interventions on the popliteal and tibial arteries, in the early postoperative period and within 180 days after such surgical treatment, where patients of the main group noted not only the preservation of positive changes for 6 months of observation, and even indicated an improvement in their physical and mental health.
When performing the doctoral thesis, the use of both classical and patented methods of endovascular diagnosis and treatment of patients with ischemic type DFS is substantiated. The introduction of new patented methods for diagnostics and treatment of this category of patients has improved the immediate and long-term results of endovascular treatment of patients with ischemic type diabetic foot syndrome.
