Khorchani B. Forecasting and individualized multimodal surgical treatment of the diabetic foot syndrome

A generalized experience is summarized of treating patients with chronic lower limb critical ischemia (CLLCI) on the background of stenotic-occlusive lesions (SOL) of the arteries is mainly popliteal-thigh-foot segment and the ulcerative-necrotic lesions (UNL) in ischemic form of DFS (IF DFS), who underwent an open, endovascular and hybrid surgical interventions on the arteries of the lower limbs and operational interventions on the feet. The system of prevention and treatment of DFS, which is based on a pathophysiologically substantiated complex of measures, in the form of an algorithm, which includes: the elimination of stenotic-occlusive lesions at the vessels, control of systemic inflammatory response and expansion of indications for carrying out balloon angioplasty in cases of the impossibility of open reconstruction due to severe concomitant pathology, the absence of plastic material or spread trophic changes in the affected limb and hybrid interventions with multilevel stenotic-occlusive lesions of arteries in patients with an ischemic form of DFS. Limiting the indications for vascular interventions can be due to technical difficulties and the presence of signs of a systemic inflammatory response syndrome, which significantly increases the risks of complications. A new comprehensive surgical treatment approach is developed taking into account the individual characteristics of the ulcerative-necrotic process in DFS patients, showed the effectiveness of the restoring the blood flow to a level of 25-30% of the final stenosis in 94.3% of cases (97.3% in stenotic lesions and 86.4% at occlusion of arteries). An analysis of the results of treatment of patients with a term of up to 12 months showed that the passability of the arteries at 1, 6, 12 months was 90%; 64% and 40%, respectively. This data indicates that isolated lesions of small diameter arteries are an unfavorable factor that affects the results of reconstructive interventions, and patients of the first year after angioplasty may be subject to preventive endovascular interference.