THE PATHOGENETIC ASPECTS OF REVASCULARIZATION OSTEOTREPANATION

A.V. Obraztsov, Ye.P. Kokhan, I.K. Zavarina, G.Ye. Mitroshin, V.V. Kozyavkin, A.V. Rzyanin
Department of Vascular Surgery, A.A. Vishnevsky Central Military Hospital,
Moscow, Russia

This work concerns the results of revascularization osteotrepanation (ROT) in 131 patients with obliterating diseases of lower extremity arteries; describes the pathogenetic mechanisms of this operation. The main group (85%) consisted of patients presenting with atherosclerotic vascular lesions, 15 patients suffered from thrombangiitis. The long-term results followed up over the period as long as two years have shown that ROT is most effective in occlusion of the femoropopliteal segment and in the distal form of lesion. The beneficial results were obtained in 64 and 37% of patients with Burger's disease and Leriche's syndrome, respectively. The stable positive results were primarily attained in patients with degree IIB ischemia. The examination methods employed (ultrasound, laser fiowmetry, nuclide scintigraphy of the extremities, thermography, pulse oxymetry, tradmill test, angiography) permitted an objective evaluation of the time course of changes in the collateral and tissue blood flow. The most remarkable changes were recorded in the medullary blood flow which rose 2-2.5-fold practically in all the patients toward the end of operation. This in turn stimulated metabolic activity in osseous and soft tissues. Postoperatively, metabolic activity in soft tissues rose by 50% and that in osseous tissue by 100%. In osseous tissue, it remained still increased 1.2-1.5-fold 2 years after surgical intervention. Angiographic, medullographic and histological studies failed to reveal the development of granulation tissue and the growth of collaterals at the sites of trepanation holes. ROT did nor exert any decompression effect, which was proved by means of osteotonometry and medullography.

KEY WORDS: revascularization osteotrepanation, oblitera-ting diseases, lower extremity arteritis.

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