['Life-saving' interventions in subacute thrombosis of crural and plantar arteries]. / 'Zhiznespasaiushchie' interventsii pri podostrom tromboze arterii goleni i stopy.

The authors report a clinical case concerning successful endovascular treatment for subacute thrombosis of crural and plantar arteries in a patient with the only leg, substantiating therapeutic decision making with due regard for the duration of thrombosis and localization of the lesion of the arterial bed. Taking into consideration the statistical data on survival in case of performing major amputation in this cohort of patients, an 'aggressive' endovascular approach including three vascularizations made it possible not only to preserve the leg but also to save the patient's life.

[Assessment of functional state of microcirculatory bed of the foot in patients with lower limb critical ischaemia]. / Otsenka funktsional'nogo sostoianiia mikrotsirkuliatornogo rusla stopy u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.

[The use of negative pressure wound therapy in patients with infectious surgical complications of diabetic foot].

In the Russian Federation diabetes affects about 11 million people. The frequency of amputation in patients with diabetes in Russia varies from 0.76 to 18.2 per 1.000 patients. From 48.9% to 60% are large amputation in which postoperative mortality reaches 50% and more. Up to half of all patients with diabetes have the defeat of major vessels of lower extremities with the formation of ischemic and neuroischemic forms of the diabetic foot syndrome. These patients are the most difficult and to save limbs need for revascularization. However, the existing algorithms of treatment of such patients do not take into account possible combination of such important pathogenetic factors, as ischemia, the prevalence of purulent-necrotic lesion of the tissues of the foot and the severity of clinical course of surgical infection. Also still not finally defined the sequence of execution of revascularization and rehabilitation of necrotic tissue, there are no indications for the use of new effective methods of treatment and rehabilitation of wounds in patients with diabetic foot. From the above, pathogenetic factors, the authors have developed a personalized Protocol of treatment of patients with ischemic and neuroischemic forms of the diabetic foot, the indications and conditions for holding therapy negative pressure. Efficiency of the proposed Protocol is accompanied by clinical examples.