[Prophylaxis of thrombotic complications in patients after reconstructive operations on the main arteries of the lower extremities, made for arteriosclerosis obliterans in a critical ischemia stage].

Results of reconstructive operations, performed on the main arteries of the lower extremities (LE) in 63 patients, suffering obliterating atherosclerosis were analyzed with the objective to analyze the causes of thrombotic complications occurrence. There was established, that common clinical screening tests, applied for control of the hemostasis system state, do not permit completely to reveal thrombophylic changes in early postoperative period timely and to prevent the occurrence of the reconstructed segments thrombosis. Direct correlation connection between the ischemia stage of the LE tissues, the reperfusion changes signs and hyperaggregation severity, occurring due to deficiency of the blood serum natural anticoagulants in patients, suffering obliterating atherosclerosis, was established.

[Perspectives of using popliteo-tibial shunting in distal portions of the lower extremities arteries lesions].

In the treatment of ischemic disorders in patients, suffering diabetes mellitus, the venous shunting toward a. pedis dorsalis and/or paramalleolar segment of a. tibialis posterior are aplied most frequently. Distal shunting was performed in 3 patients suffering critical ischemia of the lower extremities with possible alternative of amputation operation. The diameter and the state of internal vessel surface, the presence of its calcification, as well as the state of the blood inflow and outflow ways, had constituted the criterions of choice of certain segment of arteries for anastomosing. In the presence of several available vessels, the better surgical access to the artery and shorter way for shunting were taken into account. In 2 patients popliteoposterotibial shunting was performed, using autoven (1 observation) and the composed shunt (1 observation); and in one--distal anastomosis was formed with a. pedis dorsalis. In 2 mo after the operation the composed shunt thrombosis occurred. In patients, to whom autovenous shunting was performed, the regional hemodynamics indices were stable, the shunts are functioning.

[Use of simvatin for obliterating atherosclerosis after reconstructive operations on the main arteries of the lower extremities].

The results of application of simvatin in 207 patients after performance of reconstructive operations on the main arteries of femoro-popliteo-tibial segment were analyzed. Durable usage of simvatin had permitted to improve the immediate and the late results of reconstructive operations, to lower postoperative lethality significantly, caused by cardiovascular and vascular-cerebral insufficiency.

[The choice of operative method for the arterial occlusion in the femoro-popliteo-tibial segment].

The results of surgical treatment of 198 patients suffering atherosclerotic occlusion of the femoro-popliteo-tibial segment arteries were analyzed, of them endarterectomy from superficial femoral artery was performed in 75 (37.9%) patients, femoro-popliteal shunting using autovena--in 93 (47%), synthetic prosthesis--in 17 (8.6%), in 4 (2%)--distal anastomosis was formatted with "hanged" segment of popliteal artery, revascularization of the limb via the deep femoral artery system was done in 9 (4.5%) patients. Good immediate result was noted in 86.4% patients, in 2 years and more--in 68.6%. Comparative analysis of methods of the femoro-popliteo-tibial segment arteries reconstruction had trusted, that more stable indices of hemodynamics were achieved after performance of autovenous shunting with formation of distal anastomosis via proximally than the knee joint fissure localisation.

[Indications and choice of method of treatment of the lower extremities obliterating arterial atherosclerosis in elderly and senile patients with diabetes mellitus]. / Pokazaniia i vybor metoda operativnogo lecheniia obliteriruiushchego ateroskleroza arterii pozhylogo i starcheskogo vozrasta.

Results of treatment of 93 patients with diabetes mellitus and occlusive-stenotic affection of arteries of femoro-popliteal and popliteal-tibial segments were analyzed. Indications for performance of operation were established, basing on analysis of clinical manifestations of the disease and results of instrumental methods of investigation. Femoro-popliteal autovenous shunting performed in 47 (50.5%) patients, endarterectomy from the same segment--in 26 (28%), roentgenoendovascular dilatation of segments of femoral superficial and popliteal arteries--in 11 (11.8%), popliteal-tibial autovenous shunting--in 9 (9.7%). In 84 (90.4%) of patients succeeded to preserve the extremity. Postoperative lethality was 4.3%. Passability of autovenous femoro-popliteal-tibial shunts during 5 years was noted in 49.5%, passability of arteries after endarterectomy--in 38.7% of observations.