METHOD OF EXTENDED DESYMPATHIZATION WITH SIMULTANEOUS AMPUTATION IN ATHEROSCLEROTIC GANGRENE OF THE FOOT CAUSED BY RESTENOSIS OF THE VASCULAR REVASCULARIZATION ZONE

Background. Currently, it is relevant to evaluate the results of extended desympathization with simultaneous amputation of the lower limb with restenosis of its main arteries at various levels. Materials and methods. A prospective, non-randomized study involved 30 people who underwent repeated vascular reconstruction. All patients had gangrene of the toes without spreading to the tarsal. Group 1 (n=18) underwent extended desympathization after repeated reconstructive or endovascular surgery on the arteries of the lower limb. Group 2 (n=12) received repeated arterial reconstruction of the restenosis zone, with delayed amputation on the 6th to 7th postoperative day allowing for the formation of a clearly demarcated line with necrotic tissues. The average age of the patients was 58.3±0.5 years. The follow-up period was 6 months. Results. When performing amputation at various levels of the foot, its border was separated from the necrosis zone in the first group by an average of 5.01±0.11 cm; while in the second group it was 3.21±0.25 cm (p<0.05). In the experimental group, the early postoperative period was uneventful. In the control group, suppuration of the amputation stump was noted in 5 patients (41.6%), which in 3 cases (25%) required amputation at the shin level. The number of re-amputations in the groups was comparable according to the results of the 6-month follow-up. The time to complication onset was: group 1–136.3±0.5 days; group 2–98.1± 0.6 days; p<0.05. Purulent complications and repeated hospitalizations were more common in the control group (group 1–3.4±0.1 hospitalizations; group 2–6.5±0.2 hospitalizations; p<0.05). The lumen diameter of small arteries at the resection edges in the experimental group was 0.83±0.01 mm2, whereas in the control group it was 0.44±0.02 mm2 (p<0.05). Conclusions. In case of repeated vascular interventions caused by restenosis of primary revascularization zones, it is effective to perform extended desympathization of the lower limb in combination with simultaneous amputation of the toes with their atherosclerosclerotic gangrene.