Lipatov K V, Permyakov S V, Asatryan A G, Borodin A V, Gostishchev V K
Sechenov First Moscow Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
War Veterans' Hospital #1.
Khirurgiia (Mosk). 2017(9):4-16. doi: 10.17116/hirurgia201794-16.
To improve treatment of patients with grade IV chronic ischemia of lower extremities via endovascular angioplasty combined with surgical methods for suppurative-necrotic lesions of the feet.
51 patients with grade IV chronic ischemia of lower extremities underwent endovascular interventions (balloon angioplasty, stenting). A total of 23 stents were deployed in 16 patients including 12 stents in superficial and common femoral arteries, 5 in popliteal artery, 6 in iliac artery. There were no stents in crural arteries. The most perspective artery for wound healing was preferred in case of revascularization below popliteal segment. Necrectomy was performed along with angioplasty in patients with suppurative-necrotic lesion of the feet followed by delayed reconstructive operations if it was necessary.
Endovascular surgery for grade IV chronic ischemia of lower extremities was associated with good immediate results in most cases due to revascularization and organ-sparing interventions for suppurative lesions of the feet. Current endovascular methods allow to perform successful re-operations to restore blood flow in previously repaired arteries and implanted stents with restenosis or thrombosis.
通过血管内血管成形术联合手术方法治疗足部化脓性坏死病变，改善下肢IV级慢性缺血患者的治疗效果。
51例下肢IV级慢性缺血患者接受了血管内介入治疗（球囊血管成形术、支架置入术）。16例患者共置入23枚支架，其中股浅动脉和股总动脉置入12枚，腘动脉置入5枚，髂动脉置入6枚。小腿动脉未置入支架。腘动脉以下血管重建时，优先选择最有利于伤口愈合的动脉。对于足部有化脓性坏死病变的患者，在进行血管成形术的同时行坏死组织切除术，必要时进行延迟重建手术。
下肢IV级慢性缺血的血管内手术在大多数情况下能取得良好的即刻效果，这得益于血管重建以及对足部化脓性病变的保器官干预。目前的血管内方法能够成功进行再次手术，以恢复先前修复的动脉和植入支架出现再狭窄或血栓形成后的血流。
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