RESUMEN
The authors report a clinical case concerning successful endovascular treatment for subacute thrombosis of crural and plantar arteries in a patient with the only leg, substantiating therapeutic decision making with due regard for the duration of thrombosis and localization of the lesion of the arterial bed. Taking into consideration the statistical data on survival in case of performing major amputation in this cohort of patients, an 'aggressive' endovascular approach including three vascularizations made it possible not only to preserve the leg but also to save the patient's life.
Asunto(s)
Amputación Quirúrgica , Arterias , Procedimientos Endovasculares/métodos , Pie/irrigación sanguínea , Isquemia/cirugía , Recuperación del Miembro/métodos , Trombosis , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/métodos , Arterias/diagnóstico por imagen , Arterias/patología , Pie/cirugía , Gangrena/etiología , Gangrena/cirugía , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Reoperación/métodos , Trombosis/diagnóstico , Trombosis/fisiopatología , Trombosis/cirugía , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodosRESUMEN
The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.
Asunto(s)
Procedimientos Endovasculares/métodos , Pie/irrigación sanguínea , Microvasos/diagnóstico por imagen , Imagen de Perfusión , Enfermedad Arterial Periférica , Anciano , Angiografía/métodos , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Masculino , Persona de Mediana Edad , Imagen de Perfusión/métodos , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/cirugía , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Grado de Desobstrucción VascularRESUMEN
In the period from 1984 to 2010 operations were made on 41 patients aged from 36 to 76 years with chronic ischemia of digestive organs (CIDO), infarction of the small intestine was determined in 7 of them mainly due to atherosclerotic injury of the celiac trunk (CT) and/or superior mesenteric artery (SMA). In 41 patients antegrade (15) or retrograde (26) shunting of CT and/or SMA were fulfilled with synthetic prostheses in combination with resection of the small intestine in 7 patients, with lethal outcome in 2 of them only. No prosthesis infection was noted. Lethality in early terms was 17.1% mainly at the early stage of the work. Observations during the period from one month to 24 years were followed up in 26 (63.4%) patients. Their state remains satisfactory, the shunts are patent. In treatment of patients with CIDO the antegrade and retrograde shunting of CT and/or SMA are shown to be effective methods.