THE TREATMENT AND DIAGNOSTIC TACTICS IN PATIENTS WITH LESIONS OF THE AORTA AND LOWER EXTREMITY ARTERIES IN CASE OF ULCEROUS LESIONS OF THE GASTROINTESTINAL TRACT

E.R. Olevskaya, A.A. Fokin, L.A. Orekhova, I.A. Andrievskikh, I.M. Sakhnin, V.N. Koksharov
Chair of Hospital Surgery, Chelyabinsk Medical Academy,
Chelyabinsk Regional Hospital,
Chelyabinsk, Russia

Overall 747 patients with occlusive diseases of the aortoilic region and arteries of the lower extremities underwent fibroesophagogastroduodenoscopy (FEGDS) prior to operation. Gastroduodenal ulcers and erosions were identified in 33.5% of the patients examined. These diseases may cause serious abdominal complications in the intra- and postoperative periods. We have worked out a complex of therapeutic and diagnostic measures for the management of patients presenting with pathology of the aortoarterial bed associated with gastroduodenal ulcers. First of all, FEGDS is assumed to be a mandatory procedure at the preoperative period for detection of gastrointestinal tract (GIT) pathology. The further tactics depends on the stage of lower extremity ischemia. It is recommended that patients with stage IIB chronic ischemia should be treated at the Gastroenterology Department. Provided endoscopy inspection confirms the healing of ulcer and erosions, the patients may be hospitalized to the Department of Vascular Surgery for operative treatment. In patients with stage III and particularly stage IV chronic ischemia we apply medical glue to an ulcer via an endoscope just before surgery because the delay of reconstructive operations on the aortoiliac system may cost the patient extremity loss. Then, during the firs days of the postoperative period, we carry out endoscopy control. As a result of the measures undertaken, we were capable of averting gastric perforation and reducing more than fivefold the incidence of gastroduodenal bleeding. It is our belief that the treatment and diagnostic tactics under consideration is beneficial in the control and prevention of postoperative GIT complications in patients with associated occlusive pathology of the aortoiliac region and lower extremity arteries.

KEY WORDS: Pathology of the aortoarterial bed associated with gastroduodenal ulcers.

P. 100-106

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