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[Treatment of pyonecrotic complications in diabetic macroangiopathy]
Insights
Diabetic macroangiopathy causes severe immune depression in stage IV talocrural ischemia patients. Surgical reconstruction showed promising results, improving limb salvage rates.
Area of Science:
- Vascular Surgery
- Immunology
- Diabetology
Context:
- Stage IV talocrural ischemia in diabetic patients presents significant challenges due to macroangiopathy.
- Patients exhibit profound immune status depression, including reduced lymphocytes, phagocytosis, and immunoglobulins.
- Associated conditions like endotoxemia, hypercoagulation, and hyperlipidemia complicate treatment.
Purpose:
- To analyze treatment outcomes for 104 patients with stage IV talocrural ischemia secondary to diabetic macroangiopathy.
- To evaluate the efficacy of surgical reconstruction and adjunctive therapies like hemosorption and plasmapheresis.
Summary:
- Treatment involved immune status correction and surgical reconstruction using "Gore-Tex" grafts or autovein.
- Reconstruction in the aorto-ileo-femoral zone (57 patients) yielded good results in 34 cases.
- Femoro-popliteal-femoral zone reconstruction (33 patients) had good outcomes in 19 cases.
Impact:
- Highlights the critical role of immune status and vascular reconstruction in managing diabetic limb ischemia.
- Suggests that surgical interventions, despite immune compromise, can achieve limb salvage in advanced cases.
- Provides data on the effectiveness of different graft materials and surgical zones for diabetic patients.
Abstract:
Results of treatment of 104 patients aged from 47 to 82 years with stage IV talocrural ischemia (by A.V. Pokrovsky) due to diabetic macroangiopathy were analyzed. Significant depression of immune status was revealed: number of T- and B-lymphocytes decreased by 40-50%, phagocytosis--by 65-75%, number of immunoglobulins--by 25-30%. The majority of the patients had endotoxicosis, hypercoagulation and hyperlipidemia; the correction of it by hemosorption and plasmapheresis was performed depending on the disease stage. 90 patients underwent surgery. Reconstruction in aorto-ileo-femoral zone was performed in 57 patients (in 34--with good results), in femoro-popliteo-femoral zone--in 33 patients (in 19--with good results). The "Gore-Tex" grafts were the plastic material for reconstruction, but autovein in situ was also used in femoro-popliteal zone.