[VALUE OF INTRAOPERATIVE DEBITOMETRY IN SELECTING OF SURGICAL TREATMENT TACTICS FOR PATIENTS WITH DIABETES MELLITUS...

Aim - analyze the results of surgical treatment of patients with diabetes mellitus (DM) with chronic critical lower limb ischemia (CCLLI) against the background of the combined stenotic-occlusive lesions (SOL) of the femoral arterial segment (FAS) and popliteo-tibial arterial segment (PTAS), considering the data of the intraoperative debitometry (ID). The results of surgical treatment of 97 patients with diabetes mellitus with CCLLI caused by combined SOL of FAS and PTAS arteries after 1 month and 12 months of treatment were analyzed. All patients were treated at the Vascular Surgery Center of the Clinical Hospital "Feofania" of State Directorate for Affairs, Kiev, Ukraine during 2014 - 2018yrs. All patients underwent femoro-popliteal bypass grafting without intervention on arteries of PTAS.According to the obtained results of the ID, the patients were divided into groups: group 1 - 32 patients with a debit of the shunt (SD) greater than 60 ml/min, group 2 - 35 patients with SD 30-60 ml/min, group 3 - 30 patients with SD lesser than 30 ml/min. In case of the femoro-popliteal shunt (FPS) thrombosis, performed repeated surgery as a hybrid revascularization (HR) - thrombectomy from the shunt and endovascular balloon angioplasty of the arteries of PTAS. The primary patency of the arterial reconstruction zone of the patients from group 1 after 1 month was 93.75% (30 of 32), after 12 months - 78.13% (25 of 32); group 2 - after 1 month it was 82.8% (29 out of 35), after 12 months - 68.57% (24 out of 35); group 3 - after 1 month it was 46.66% (14 out of 30), after 12 months - 23.33% (7 out of 30). Thrombosis of the femoropopliteal shunt (FPS) within 12 months was diagnosed in 41 (42.27%) of 97 patients, within these patients 1 month after primary shunting in 26 (63.41%), and during the next 11 months in 15 (36.59 %)cases.With repeated intervention on thrombosis ofFPSin form ofHR, secondary patency within 12 months was 78.05% (32 of 41 patients).Restoration of the outflow from the popliteal artery in one of the tibial arteries by HR was possible in 28 of 41 (68.29%) patients, within 12 months rethrombosis of the arterial reconstruction zone occurred in 8 patients (28.57%) - with secondary patency after 12 months of 71.43% (20 of 28 patients). The restoration of the outflow from the popliteal artery into two tibial arteries by HR was possible in 13 of 41 (31.71%) patients, from them rethrombosis of the FPS within 12 months occurred in 1 patient (7.69%) - the secondary patency within 12 months was 92.31% (12 of 13 patients). In the case of combined SOL of FAS and arteries of PTAS, reconstruction of FAS without intervention on the arteries of PTAS requires performing of ID with determining of SD. Performing of ID with determining of SD is an effective diagnostic technique that allows to formulate a differentiated approach to the tactics of surgical treatment of patients with diabetes mellitus with CCLLI, caused by the SOL of FAS and PTAS. The indicator which allows to restore the patency of FAS without intervention on the arteries of the PTAS is SD>60 ml/min; with SD 30-60 ml/min, the reconstruction of the arteries of the PTAS after the restoration of the patency of FAS can be delayed and performed as elective surgery at the second stage; with SD<30 ml/min, simultaneous reconstruction of FAS and PTAS arteries is required by performing HR or two-stage open arterial reconstruction. The HR is an effective method of blood circulation restoration in patients with diabetes mellitus with CCLLI, caused by a combined SOL of FAS and PTAS, and according to the results: the patency of the FPS within 12 months is 78.05% and does not significantly differ from the results of FAS reconstruction in 1st group of patients with SD>60 ml/min - where patency of the FPS within 12 months is 78.13% (p>0.05). In case of thrombosis of the FPS, thrombectomy from the shunt, supplemented by the restoration of the magistral blood flow from the popliteal artery into two tibial arteriesby the method of balloon angioplasty, demonstrates reliably better secondary patency of the femoropopliteal shunt after 12 months - 92.31% in comparison with the secondary patency of the FPS within 12 months after restoration of the magistral blood flow from the popliteal artery into one tibial artery - 71.43% (p<0.05).