SURGICAL APPROACH TO MANAGEMENT OF PATIENTS WITH ACUTE ARTERIAL ISCHEMIA OF LOWER LIMBS WITH THE UNDERLYING ATHEROSCLEROTIC LESION OF ARTERIES

Aim. To improve the diagnosis and to optimize surgical approach to treatment of patients with acute ischemia of the lower limbs and severe ischemia of a limb depending on the prognostic criteria of surgical treatment. Materials and Methods. 152 Patients with acute arterial occlusion (82 men –53.9%, 70 women – 46.1%), aged 67.4±3.7 years, were examined. The patients were divided into 3 groups: 1 – 58 patients (38.1%) with arterial embolism; 2 – 10 patients (6.6%) with thrombosis of the lower limbs with non-identified causes; 3 – 84 patients (55.3%) with arterial thrombosis with the underlying atherosclerotic lesion of arteries. All patients underwent general clinical examination, duplex ultrasound of lower limb arteries, angiography. In 136 patients the extent of skeletal muscle damage and the state of acid-alkaline balance were studied. Results. In 73% of the examined patients hemodynamically significant atherosclerotic occlusive-stenotic lesions of lower limb arteries were found. For patients with acute arterial occlusion and atherosclerotic lesion of the lower limb arteries, a stepwise management tactic was developed, which consisted in successive thrombectomy, angiography of arteries, followed by various endovascular and open shunting reconstructive operations on the arteries of the lower limbs. Prognostic criteria that determine the tactics of patient management and of preservation of limb viability were developed.