[Surgical treatment of symptomatic aneurysm of popliteal artery].

The results of treatment of 17 patients, suffering symptomatic aneurysm of popliteal artery (APA) were analyzed. According to angiographic data, the APA thrombosis was revealed in 6 patients, and according to ultrasonographic Doppler scanning data the APA rupture with hematoma in adjacent tissues was diagnosed in 5 patients. The tactics of treatment was established in accordance with the distal blood flow character: the conservative therapy was conducted in the presence of APA up to 40 mm in diameter in condition of the artery passability preservation and poor distal blood flow--in 6 observation operative treatment was conducted in the presence of satisfactory distal blood flow--in 4, according to urgent indications due to critical ischemia--in 2, and for the aneurysm rupture--in 5. Operative treatment of symptomatic APA showed ineffective in presence of thrombotic complications in 23.1% patients. In conservative and surgical treatment of APA, complicated by an acute thrombosis, the poor results (the lower extremity amputation) were noted in 33.3% patients.

[Experimental substantiation of the new method of hemostasis].

The article provides the results of experimental welding occlusion of arterial and venous vessels 2-12 mm in diameter, including 998 bench tests of resected animal vessels, 256 bench tests of resected human vessels, and also experiments involving 42 live animals (pigs). During the above-mentioned tests 748 vessel obturations were performed. Manual regimen of welding enables the leakproof obturation of the vessel in 66.4% of animals, the result was instable in 22% of cases, no obturation was achieved in 11.6%. Selecting the optimal automatic regimen, we obtained the best results during whelming with the use of the program N.6. The mean strength of the suture obtained in 98.2% of cases was 91,066.7 +/- 215.20 mm Hg. The instable outcome of welding in 1.8% of cases of the use of program N 6 was the result of the use of different welding instruments. The best results (1324 +/- 258) mm Hg were obtained when the electrodes of the welding clamp were compressed at one peg and the force of compression was 91.9 +/- 0.2) MPa. We have established that the short-term impact of increased temperature (from (56 +/- 1.9) to (81 +/- 2.7) degrees C enables denaturation and coagulation of protein molecules, which results in welding connection without coagulation necrosis.

[The role of revascularization in the foot salvage in patients suffering diabetes mellitus with occlusion-stenotic lesions of the shin arteries].

There were examined 1363 patients suffering diabetes mellitus with trophic ulcer and purulent-necrotic affection of foot. Conservative treatment or operative intervention on the foot were conducted according to indications in 1176 (86.3%) patients, who no needed revascularization. Revascularization was done in 187 (13.7%) patients. Necessity of reconstruction for occlusion-stenotic affection of the shin arteries was established in 125 (66.8%) of them, shunting into the foot arteries was done in 52 (41.6%). High amputation of the limb was performed in 73 (58.4%) of patients in presence of contraindications for the foot revascularization. In 83.5% of patients suffering diabetes mellitus with occlusion-stenotic affection of the shin segment arteries there were two or one passable arteries of foot, fit for shunting operation.

[Treatment of neurological component of venous insufficiency of the lower extremities].

Based on a personal experience of the treatment of venous insufficiency of low extremities, was selected a group of 31 patients from 167 patients with trophic disorders resulted from venous insufficiency of low extremities. The patients of the selected group had along typical venous insufficiency related symptoms a neurological syndrome which was typical for the tarsal canal. Neurological disorders in 26 patients may be caused by a long persisting ulcer and chronic regional inflammation against venous hypertension. The syndrome of the tarsal canal in 5 patients may develop as recurrence of venous disease following the surgical operation after Linton. The patients of the selected group underwent final correction of venous hemodynamics, decompression and neurolysis of posterior tibial nerve in the tarsal canal.

[Efficacy of vascular therapy in complex of treatment of purulent necrotic foot ulcers in patients with diabetes mellitus]. / Efektyvnist' sudynnoï terapiï v kompleksi likuvannia hniino-nekrotychnoho urazhennia stopy u khvorykh na tsukrovyi diabet.

The result of treatment of purulent-necrotic affection of foot (PNAF) in 151 patients with diabetes mellitus (DM) was estimated. The conduction of preoperative medicinal therapy is mandatory for the general status of patient stabilization only. After prescribing of heparin, no-spa, papaverin, rheopolyglucinum, solcoseryl, aspirin the foot tissues blood supply is changing nonvitally, the foot tissues blood supply while the alprostan intravenous infusion improves significantly. The alprostan prescription during performance of operative intervention on foot in patients with PNAF, caused by DM, and in the collateral blood flow decompensation of the leg and foot arteries is mandatory.

[Diagnosis and treatment of the main arteries in the lower extremities of patients with diabetic foot syndrome]. / Diahnostyka ta likuvannia urazhennia mahistral'nykh arterii nyzhnikh kintsivok u khvorykh na tsukrovyi diabet.

Results of examination and treatment of 209 patients with diabetes mellitus (DM), complicated by purulent-necrotic affection of foot (PNAF), were analyzed. While choosing patients to determine indications for reconstructive operation performance segmentary pressure (SP) on posterior tibial artery on level of her low third was measured, shoulder-scapular index (SSI) and the PNAF stage (according to classification of Wagner) were determined. In 16% of patients with diabetic affection of III-IV stages, SP indexes ranging 9.3-12.0 kPa (70-90 mm Hg), SSI 0.6-0.9 stenosis or occlusion of the lower extremity main arteries, demanding surgical correction to be done, was revealed. Reconstructive operation on vessels was done in 26 patients with restricted stenosis of femoro-popliteal segment, according to ultrasonic Dopplerometry results, passability of the leg arteries, distance of more than 50 metres, which passes patient without painful sensations, value of SP in both arteries of leg ranging 9.3-12.0 kPa (70-90 mm Hg), SSI more than 0.6. Revascularization operation on arteries of lower extremity was successful in 46 (94%) of 49 patients with DM and PNAF.