Immediate and Long-term Results of Revascularizing Osteotrepanasion and Lumbar Sympatectomy in Patients with Critical Ischemia of The Lower Extremities (Correlation and Statistical Analysis)

Kosayev JV¹*, Abushov NS², Ahmadov MB³, Taghi-zade GT¹, Guliyev RA⁴, Budagov IK⁵, Aliyev EN⁶, Ibrahimova GR⁷, Ahmadov SR⁷ and Murvaladova NF^8
1Candidate of Medical Sciences, Chief Researcher of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan
²Doctor of Medical Sciences, Professor, Head of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad.M.A. Topchubashev, Baku, Azerbaijan
³Candidate of Medical Sciences, Head of the Department of Extracorporeal Detoxification of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan
⁴Candidate of Medical Sciences, Head of the Department of Vascular Surgery, Baku, Azerbaijan
⁵Surgeon of the Department of Vascular Surgery, Baku, Azerbaijan
⁶Researcher of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan
⁷Junior Researcher of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan
⁸Resident Surgeon of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan
*Corresponding Author: Kosayev JV, Candidate of Medical Sciences, Chief Researcher of the Department of Vascular Surgery of the Scientific Center of Surgery named after acad. M.A. Topchubashev, Baku, Azerbaijan.

Published: July 03, 2024

DOI: 10.55162/MCMS.07.225

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Abstract  

Objective: To study the immediate and long-term results of revascularizing osteotrepanation and lumbar sympathectomy in patients with critical ischemia of the lower extremities (CILE) on the background of distal arterial steno-occlusion.

Material and methods: The results of standard treatment and the use of various types of indirect revascularization in 171 patients with CILE against the background of distal arterial steno-occlusion were analyzed. The etiological factors of CILE were obliterating atherosclerosis (115 patients) and thromboangiitis obliterans (56 patients). The level of arterial damage: femoropopliteal segment -26 (15.2%), popliteal-tibial segment -56 (32.7%), tibial-foot segment -50 (29.2%), foot - 25 (14.6%), multilevel lesion -14 (8.2%). To establish a diagnosis and assess the results of treatment, changes in the clinical status of patients were traced, Doppler ultrasound with angioscanning, multispiral computer-tomographic angiography, rheovasography were performed, and skin oxygen saturations were determined. The immediate results of treatment were assessed by the Rutherford R.B. et al. (1997) scale.

Results: 48 patients (control group) underwent standard treatment. The following types of indirect revascularization were performed to stimulate regional circulation: revascularizing osteotrepanation (ROT) in 64 patients, lumbar sympathectomy (LSE) in 59 patients. In patients with CILE against the background of distal arterial steno-occlusion, ROT and LSE improve the immediate and long-term results of surgical treatment, make it possible to preserve the supporting function of the limb, reduce the frequency of rehospitalization, and continue an active lifestyle.

Conclusions: Correlation and statistical analysis revealed a significant dependence of the results obtained on the method of revascularization. The technical simplicity of performing the operation of ROT and LSE creates the prerequisites for the introduction of surgical departments of multidisciplinary clinics in daily practice.

Keywords: distal occlusion of the arteries; critical ischemia of the lower extremities; revascularizing osteotrepanation; lumbar sympathectomy

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