Clinical and Hemodynamic Aspects of Treatment of Patients with Critical Ischaemia of the Lower Extremities with Severe Concomitant Diseases

Objective: To study the clinical and hemodynamic aspects of treatment of patients with critical ischemia of the lower extremities with severe concomitant diseases. Material and methods of research:The study was carried out in 48 patients with LLI (III-IV stage of ischemia according to the Fontaine-Pokrovsky classification).Men -30, women -18.The etiological factor for the development of CLI in 34 (70.8%)patients was obliterating atherosclerosis, in 14 (29.2%)patients -thromboangiitis obliterans.In 16 (33.3%)patients, critical ischemia of the III degree was diagnosed, in 32 (66.7%) patients -in the IV degree.To diagnose and assess the effectiveness of treatment, a clinical study, rheovasography, Doppler ultrasound, multispiral computer-tomographic angiography were carried out, oxygen saturation of the skin, indicators of regional arterial and venous blood flow were studied.Outcomes: During their stay in the clinic, patients with stage IV chronic ischemia underwent minor amputations in 24 (75%) patients, in 8 (25%) -major amputations, in 40 (83.3%)patients out of the total number of examined patients retained the supporting function of the limb.In the remote period, within 6 months.Up to 5 years of age, 36 (83.7%) patients were re-hospitalized, 10 (23.3%) patients underwent minor amputations, 22 (51.2%) had major amputations, and 21 (48.6%)patients out of 43 re-examined patients retained the supporting function of the limb. In 48 examined patients, upon admission to the clinic, in comparison with the "reference" group, a significant (p>0.001)deterioration of the indicators of RI, SSO, LVBF, RSP standing and lying, POVP standing and lying, VAI standing and lying down, RSPG, POVPG was revealed.After treatment, there was an insignificant (p>0.05)positive trend.After 3-4 months.after discharge from the hospital, in comparison with the initial data, only the indicators of RI, SOO, LVBF and standing VAI significantly improved (p<0.05).Conclusion: Traditional conservative and surgical treatment of patients with CILE with severe concomitant diseases is not significantly (p>0.05) and stimulates regional circulation.In the near future, the support function was retained in 83.7%.In the remote period, within 6 months.83.7% of patients under 5 years of age were re-hospitalized, the support function was preserved in 48.6% of patients.