[Efficacy of two-level infrainguinal reconstructions in treatment of chronic critical lower limb ischaemia].

AIM: to determine the scope of infrainguinal revascularization of the limb in patients with multilevel lesions of arteries in chronic critical lower limb ischaemia (CCLLI). MATERIAL AND METHODS: A retrospective analysis of graft patency and limb salvage included a total of 76 patients undergoing a total of 78 bypass procedures consisting of: 1) two-level infrainguinal reconstructions (n = 35), 2) femoral-tibial (n = 36) and femoralplantar (n 7) bypass procedures. All patients had an isolated segment, of the popliteal artery in a combination with bifurcation arterial occlusive disease. Autovenous reversed retrograde and orthotopic in (situ vein grafts were used. All patients underwent intraoperative haemodynamic measurements. Graft patency was assessed by Doppler monitoring. The two groups studied were compared by demographic features and risk factors by means of the Student's and chi-squared tests. RESULTS: Life-table analysis showed demonstrated that two-level infrainguinal reconstructions provided better primary 3-year patency (76.2%) as compared with femoral-tibia! and plantar bypasses (60.4%, p<0.05). Intraoperative mortality occurred in 2 patients (2.5%). Early and mid-term thromboses appeared to be most frequently encountered in the group of femoral-tibial, and plantar reconstructions (18.6% vs 11.4%, p<0.38 and 30.8% vs 10.3%, p=0.04, respectively). CONCLUSION: Two-level infrainguinal arterial reconstruction in patients with CCLLI is an acceptable procedure alternative providing better graft patency higher limb salvage rate as compared with femoral-tibial or femoroplantar bypass.

[Strategies of surgical treatment of hemorrhage in postinfection damage of the main vessels in patients with substance dependence]. / Taktika khirurgicheskogo lecheniia krovotecheniia pri postin"ektsionnom povrezhdenii magistral'nykh sosudov u bol'nykh s narkoticheskoi zavisimost'iu.

There was summarized experience of surgical treatment of 88 patients with narcotic dependence, in whom the hemorrhage have occurred due to postinjection injury of the main vessels. Reconstructive-restorational operations were conducted in acute period in the absence of sepsis, hemorrhagic shock and vast focus of infection, using auto vein and in the remote period--synthetic prostheses. All the patients, suffering narcotic dependence, admitted to the clinic, are considered as probably AIDS-infected. Medical staff, performing medicinal care in such patients, must be provided with the individual defense facilities.