Paths of collateral blood circulation with stenotic-occlusive lesions of the femoro-popliteal and cruro-pedal arterial segments in patients with ischemic form of diabetic foot syndrome
Aim. To study the features of collateral blood circulation in the occlusion of the femoral-popliteal and cruro-pedal arterial segments in patients with ischemic form of diabetic foot syndrome.
Material and Methods. An analysis of the histories of the disease and angiograms of 103 patients with type II diabetes mellitus complicated by the IF SDS with chronic critical ischemia of the lower limb against the background of the stenocally occlusive lesion of the superficial femoral artery and arteries of the cruro-pedal segment, provided that the full or partial patency of the popliteal artery was carried out. The group of patients included 58 (56.3%) males, and 26 (43.7%) females, aged 59 to 75 years. The average age was 65.2±5.1.
Results and Discussion. Of the 103 patients included in the experimental group, according to the classification of I.I. Sukharev (1995) 35 (34%) of them corresponded to type 2, 27 (26,2%) - type 3, 24 (23,3%) - type 4 and 17 (16,5%) - type 6 were distinguished by the character of the combined lesions of arteries of the femoro-popliteal and cruro-pedal segments. Patients in the experimental group were divided into group A (71 patients) and group B (32 patients) on the basis of the patency or obstruction of the main arteries of the foot. According to the features of the angioarchitectonics at the level of the shin segment, patients of the group B had three types of collateral circulation. In Type 1, there was a developed network of collateral vessels from the system of the arterii tibialis and fibularis with contrasting plantar arteries - 11 patients; Type 2 - a developed network of collateral vessels from the system of the suralis arteries, the subcutaneous branch of the descending artery of the knee, the lower branch of the lateral artery, which envelops the femoral bone and the fibularis artery with the contrast of the plantar arteries. The formation of anastomoses between the branches of the suralis arteries and fibularis arteries was characteristic in 12 patients; Type 3 - undeveloped network of collateral arteries of the leg, arteries of the foot were not contrasted - in 9 patients. In the case of proven insufficiency of the paths of collateral blood circulation at the level of the cruro-pedal segments according to the angiography data in patients of group B (type 3), when direct and mediated revascularization is not possible, the use of non-standard methods of foot revascularization, such as transplantation of the skin-musculo-fascialis flap or segment of a omentum major on the vascular stalk, arterialization of the venous bed of the foot, and trepanation of the shin bones are indicated.
Conclusions. The distribution of patients with combined stenotic-occlusive lesions of femoral superficial artery and the arteries of the cruro-pedal segments into groups A and B (type 1, 2, 3) allows specifying further therapeutic procedure in this category of patients. When performing "direct revascularization", the healing time of ischemic ulcerative-necrotic lesions of the foot decreases by 2.3 times compared with the results of "mediated revascularization".
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