[Revascularising osteotrepanation in treatment of lower limbs critical ischemia]

The results of treatment of 202 patients with chronic critical ischemia of the extremities by the method of revascularising osteotrepanation are presented. There were 139 patients with atherosclerosis (AO) and 63 with thromboangiitis obliterans (TO). 69% of (AO) patients showed improvement of the circulation exactly after the operation 73%--in 1 year, 65%--in 3 years and 52%--in 5 years. In TO patients these percentases were--88%, 78%, 73%, 58%, respectively. It was established that the operation is most effective in TO and in distal forms of atherosclerosis. In occlusions of aorto-iliac segment it is indicated when rautine reconstruction procedure is impossible. In patients with severe and protracted painful syndrome unresponsive to narcotics, with "positional" oedemas and humid gangrene of the foot the operation is not advisable. Curative effect increases when revascularising osteotrepanation is combined with profundoplasty, sympathectomy, femoro-popliteal bypass grafting and devitalisation of the adrenal glands.