INTRAOPERATIVE DYNAMIC KINESIOMANOMETRY IN SURGICAL TREATMENT OF ARTERIAL ISCHEMIA

A.N. DUNDZYA, A.N. SCHERBUK. S.A. DADASHOV, K.A. ANTSUPOV

I.M. Sechenov First Moscow State Medical University.

University Clinical Hospital No 1, Moscow, RUSSIA

Introduction. about 3 million people in the Russian Federation suffer from atherosclerotic injuries of arteries of lower extremities, about 5% have critical ischemia, which leads to a high amputation and loss of extremities in 1.3% annually. Surgical intervention directed at the direct restoration of the main blood flow and is likely in 77% - 83% of patients. In the remaining 17% - 23% of patients, diffuse injury of the arterial bed, distal to the crural arch is observed.

Purpose. Forecasting of the functioning of arterial reconstruction in patients with distal injury of arteries of lower extremities in the surgical treatment of arterial ischemia.

Materials and methods: The main methods, based on which indications and contraindications for different types of surgery on the arteries of the lower extremities are determined, are straight angiography, multispiral computer angiography (MSCT), an index of regional systolic pressure (cuff test). However, there is no direct parallelism between the identified angiographic changes of the vascular bed and its resistance to blood flow.

100 patients of the Department of Vascular Surgery of the I.M. Sechenov First MGMU, who were operated on the arteries of the lower extremities within the period from 2006 to 2010 were objects of the study. Patients were divided into 2 groups. The 1^st group consisted of patients with diffuse distal injury of arteries of lower extremities and suspicious operability according to MSCT and ultrasound (40). The II group included patients with satisfactory distal vascular bed and expected positive results of surgical intervention (60). All patients prior to reconstructive surgery, intraoperatively were performed preliminary perfusions by blood substituting solution of the distal vascular bed in normal production mode of the artery (kinesiomanometry) and were performed forecasting of the further functioning of the vascular reconstruction, given the patient’s hemodynamic parameters, and later there were performed reconstructive operation on the arteries of the lower extremities.

Results: This study for the first time allowed to obtain new data on the dependence of the distal vascular resistance on the pathological changes of vessels. Criteria for the forecasting of the functioning of vascular prosthesis subject to the dynamic kinesiomanometry data are developed.

Conclusion. Comparison of capabilities of intraoperative dynamic kinesiomanometry, computer angiography and ultrasound methods of study, in the assessment of the condition of distal vascular bed, allows to optimize tactics and amount of surgical intervention in patients with distal vascular lesions.

Date: 2014-12-28; view: 1047