Diseases of peripheral vessels
Diseases of peripheral vessels – critical lower limb ischemia (CLLI), obliterating atherosclerosis of vessels of lower limbs, diabetic foot syndrome.
In critical ischemia of the lower limbs, rest pain requiring pain relief is noted with a decrease in systolic pressure in the distal third of the shin less than 50 mm Hg. and / or systolic pressure on the digital arteries below 30 mm Hg. or the presence of trophic ulcers or gangrene of the foot or fingers with the same values of systolic blood pressure.
The causes of the development of critical ischemia of the lower limbs can be a number of diseases:
- Obliterating atherosclerosis
- Diabetic Foot Syndrome
- Peripheral thrombosis / embolism with atrial fibrillation, mitral valve defects, aortic aneurysms and iliac arteries
- Consequences of mechanical trauma of the artery
- Obliterating endarteritis
- Nonspecific aortoarteritis (Takayasu’s disease)
- Obliterating thromboangiitis (Buerger’s disease)
Despite such a variety of reasons for the development of CLLI in the vast majority of patients, this pathological condition develops as a result of atherosclerosis and diabetic foot syndrome. According to significant risk factors for the development of CINC, diabetes mellitus, smoking and advanced age.
Regardless of the mechanism of diseases that led to the development of ischemia, the immediate cause of pain in the lower limb, the appearance of trophic ulcers and necrosis – narrowing and blockage of the arteries of blood supplying the lower limbs, the termination of the main blood flow along them.
The treatment of this group of patients is a complex problem. In many cases, vascular reconstructive interventions are difficult to perform or even impossible due to the presence of diffuse multifocal lesions, arterial lesions of distal lower limbs, which is typical for patients with diabetes mellitus and the presence of purulent necrotic changes, infected wounds in the foot area, expressed concomitant pathology.
The possibility of conservative treatment and indirect methods of revascularization in these patients is usually also exhausted, which leads to the need for amputation. The frequency of lethal outcomes after performing amputation in the early postoperative period with a transmetatarsal foot amputation reaches 5.6%, with a leg amputation 5-10% , hips 15-20%. Mortality in patients with critical ischemia of the lower limbs within 30 days after high amputation is 25-39%, within 2 years – 25-56%, and after 5 years – 50-84%.
Under such conditions, the appearance of the possibility of restoring the blood stream in patients with critical ischemia of the lower limbs means the possibility of preserving the limb, and the preservation of the limb means the preservation of social functions and the life of the patient.
In recent years, thanks to the development of endovascular surgery, the emergence of the technique of subintimal angioplasty was made possible by minimally invasive x-ray surgery-angioplasty and stenting-to restore the lumen of vessels with long blockages of the lumen of the vessel, “multi-storey” lesions, lesions of the arteries of the shin and foot.
The goal of endovascular intervention is to restore the lumen of the vessels and provide the main blood flow to the distal sections of the lower limbs. Restoration of blood flow creates conditions for the healing of trophic ulcers and wounds.
Gangrene of the foot. Defeat of the arteries of the shin. Balloon angioplasty of the lower leg arteries.
Lesion of femoral and tibial arteries before and after angioplasty