Algorithm of tactical-surgical approach to performance of percutaneous transluminal balloon angioplasty according to the data of transcutaneous Oximetry in patients with critical ischemia with diabetic foot syndrome
DOI:
https://doi.org/10.11603/2414-4533.2022.3.13389Keywords:
diabetic foot syndrome, critical ischemia of the lower extremities, transcutaneous oximetry, percutaneous transluminal balloon angioplastyAbstract
The aim of the work: to study the peculiarities of blood circulation in the periphery of the lower extremities according to the data of transcutaneous oximetry in patients with the neuroischemic form of the diabetic foot syndrome before and after the performance of balloon angioplasty, to develop an algorithm for its performance depending on the characteristics of purulent-necrotic complications.
Materials and Methods. The study was performed on 67 patients with type II diabetes, who, according to clinical data, ultrasound of the arteries of the lower extremities, indicators of the ankle-brachial index, computer tomography of the vessels of the lower extremities, as well as the method of transcutaneous oximetry, confirmed the neuroischemic form of the diabetic foot syndrome. The patients were divided into 3 groups: group 1 included 18 patients with dry gangrene of one or more fingers or the distal part of the foot; group 2 – 35 patients with wet gangrene, signs of purulent arthropathy of the toes, phlegmon of the foot, patients with non-healing stumps who had amputations in the anamnesis and with extensive chronic purulent-necrotic wounds on the feet and lower legs; Group 3 – comparison group consisted of 14 patients who were diagnosed with purulent-necrotic complications, which were observed in both groups 1 and 2, but they refused to undergo balloon angioplasty. Such patients, after performing surgical correction, were given conservative therapy according to the "Protocol for the provision of medical care to patients with diabetic foot syndrome".
Results and discussion. The results of the research showed that all patients with critical ischemia of the lower extremities with diabetic foot syndrome with signs of dry or wet gangrene have a low TcpO2 level, namely, less than 30 mmHg, which corresponds to decompensated tissue metabolism and is a direct indication of performance of any method of revascularization or even amputation. At the same time, the features of the differences in the restoration of blood circulation in the time interval in patients without purulent complications compared to those diagnosed with wet gangrene, which was accompanied by swelling of soft tissues or the presence of long non-healing purulent-necrotic wounds, were noted. Therefore, the question of phasing, namely – the priority of balloon angioplasty or still primary surgical treatment in this or that situation is of primary importance in the further achievement of positive results of a complex approach to the surgical treatment of this pathology.
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