DIAGNOSTIC AND THERAPEUTIC POSSIBILITIES OF LUMBAR CHEMICAL SYMPATHECTOMY IN PATIENTS WITH CHRONIC OBLITERATING DISEASES OF LOWER-LIMB ARTERIES

Sukovatykh B.S., Itinson A.I., Knyazev V.V., Magamedaliva K.S., Savchuk O.F.
Chair of General Surgery Kursk State Medical University,
Kursk, Russia

The authors have analysed the findings obtained in a comprehensive examination followed by surgical management of eighty-five patients presenting with chronic obliterating diseases of lower limbs arteries (CODLLA).

Studying the macrohaemodynamics and microcirculation of the ischaemic extremity was carried out according to the diagnostic programme for the disease concerned: i.e., rheovasography, photoplethysmography, transcutaneous oximetry, ultrasonographic duplex scanning of the lower-limb arteries, and angiography. All the patients were found to have signs of critical ischaemia of the lower extremities on the background of a concomitant lesion of the vessels of the femoropopliteal and crural segments. However, no reconstructive operations were performed owing to occlusion of the arteries of the feet and crura, and the patients were therefore subjected to surgical procedures aimed at indirect revascularization of the extremity involved.

The patients were divided into two groups (Group One and Group Two, comprising 45 and 40 patients, respectively). The forty-five Group One patients were subjected to revascularizing osteotrephination (ROT) of the femur and cms in the sites with sufficient blood supply, as determined by duplex scanning. We managed to relieve the symptoms of critical ischaemia in 82.2% of the patients from this group. The manifestations of ischaemia were noted to be gradually increasing in seven (15.6%) patients during the postoperative period, and they all had to be subjected to a high amputation of the affected extremity. Whereas, the forty Group Two patients underwent ROT supplemented by ultrasonography-controlled lumbar chemical sympathectomy (LCS). A combination of LCS and revascularizing osteotrephination made it possible to stop ischaemia in 90% of the patients suffering from critical ischaemia of the lower limbs, and to reduce the rate of amputations by 5.6%.

KEY WORDS: lumbar chemical sympathectomy, revascularizing osteotrephination, critical ischaemia.

P. 32-36

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