Cost-benefit analysis of the use of invasive intraoperative hemodynamic control of the state of peripheral blood flow in endovascular or hybrid reconstruction of multisegment lesions in chronic arterial occlusive disease of the lower extremities

Objective: to evaluate the cost-benefit ratio of the use of invasive intraoperative hemodynamic control of peripheral blood flow during correction of multilevel lesions in chronic arterial occlusive disease of the lower extremities.Material and methods. We compared the cost of the in-hospital period of treatment among patients of 3 comparable groups: the patients of the first group underwent interventions under angiographic control, of the second — under invasive intraoperative hemodynamic control of the state of peripheral blood flow in addition to angiography, and in the patients of the third group invasive hemodynamic control of the state of peripheral blood flow was followed by pharmacological tests.Results. The use of the given method made it possible to correct the extent of the performed procedures of revascularization and to estimate the efficiency of the phases of the operation in real time. The result of interventions in the groups with hemodynamic control was a reliable increase of the ankle-brachial index (ABI index) values (p — 00001) in shorter length of segments after revascularization (p — 0.05). At the same time, the reduced extent of the correction resulted in saving 807 BYN per case.Conclusion. The use of invasive intraoperative hemodynamic control allows of reducing the extent of the reconstruction in multisegment lesions with the achievement of satisfactory clinical outcomes with lesser economic costs.

Lower Extremity Amputation for Ischemia

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed. Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references

Lower Extremity Amputation for Ischemia

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed. Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references