The role of the angiosomaly-oriented endovascular revascularization method in the complex treatment of diabetic foot syndrome

V. Petrova, G. Smirnov, M. N. Arzhelas
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Abstract

Objective: analyze the effectiveness of the angiosomal oriented endovascular revascularization method in the complex treatment of diabetic foot syndrome (DFS). Materials and methods. One of the most serious complications of diabetes mellitus is damage to the vessels of the lower extremities. In diabetic macroangiopathy, an extended lesion of medium-sized arteries occurs, which, coupled with an atherosclerotic lesion, often leads to the formation of arterial stenosis and occlusion. The leading method for correcting the patency of the great vessels today is endovascular balloon angioplasty. The study examined the feasibility of selective angiosomal revascularization of the lower extremities. The advantages of angiosomaly-oriented endovascular revascularization are a reduction in the duration of the intervention, a decrease in the volume of the injected contrast drug, and targeted restoration of blood flow in the arteries that feed the affected segment of the limb. The study included 49 patients with a neuroischemic form of DFS with hemodynamically significant stenosis and occlusion of the lower extremities arteries. Patients were divided into 2 groups. Patients of both groups underwent complex conservative treatment and performed operations on the lower extremities (from surgical debridement to below the knee amputation). Patients of the first group underwent angiosomaly oriented revascularization of the lower extremities. Patients from the second group underwent traditional endovascular revascularization. Results. After angiosomaly oriented revascularization, a complete restoration of the initial diameter of the vessel was achieved in 80.0 % of cases, the absence of residual stenosis – in 82.5 %, the absence of intimal dissection – in 95.0 % of cases. It was possible to achieve laminar blood flow in 90.0 % of cases. A reduction in the revascularization procedure by an average of 30 minutes and a decrease in the consumption of contrasting pharmaceuticals by an average of 100.0 ml are shown. Conclusion. When evaluating the results of complex treatment of patients after angiosomaly oriented revascularization, a decrease in the average hospital stay (11 and 13 days, respectively), a decrease in the average healing time of a wound defect by 1.25 times, a decrease in the average duration of ulcerative epithelization (9 and 13 days, respectively) and a decrease in the volume of surgical intervention and the number of high amputations during the year after angioplasty compared with patients who underwent endovascular revascularization according to the traditional method.
血管体定向血管内血管重建术在糖尿病足综合征复杂治疗中的作用
目的:分析血管小体定向血管内血管重建术在糖尿病足综合征(DFS)综合治疗中的效果。材料和方法。糖尿病最严重的并发症之一是下肢血管的损害。在糖尿病大血管病变中,中等动脉病变扩大,并伴有动脉粥样硬化病变,常导致动脉狭窄和闭塞的形成。目前矫正大血管通畅的主要方法是血管内球囊血管成形术。本研究探讨了选择性下肢血管体重建术的可行性。以血管躯体为导向的血管内血管重建术的优点是缩短了干预时间,减少了注射造影剂的体积,并有针对性地恢复了肢体受影响部分的动脉血流。该研究包括49例神经缺血性DFS患者,伴有血流动力学上明显的下肢动脉狭窄和闭塞。患者分为两组。两组患者均进行了复杂的保守治疗,并对下肢进行了手术(从手术清创到膝下截肢)。第一组患者行下肢血管成形术。第二组患者行传统血管内血管重建术。结果。在血管成形术后,80.0%的病例血管初始直径完全恢复,82.5%的病例没有残留狭窄,95.0%的病例没有内膜夹层。在90%的病例中有可能实现层流血流。血运重建过程平均减少30分钟,对比药物的消耗平均减少100.0毫升。结论。在评估血管成形术后患者的综合治疗结果时,平均住院时间减少(分别为11天和13天),伤口缺损平均愈合时间减少1.25倍,溃疡性上皮平均持续时间减少(9天和13天)。与传统方法行血管内重建术的患者相比,血管成形术后一年内的手术干预量和高位截肢数量均有所减少。
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