RU2368344C1 - Method of treating obliterating atherosclerosis of lower limb arteries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to vascular surgery. Osteotrepanation openings are made in shin bone and fibular bone by drill of small diametre. Talk is introduced into muscular mass and hypodermic cellular tissue of shin, together with intraosseous detritus taken from canal of shin bone.

EFFECT: method ensures improvement of arterial blood flow, long stimulation of microcirculatory channel of limb.

2 ex.

Description

The invention relates to medicine, namely to vascular surgery, and can be used in the treatment of atherosclerosis obliterans of the arteries of the lower extremities (OAANK).

At present, a fairly large number of methods for surgical correction of arterial blood flow in the AAAA are known and used in practice: reconstructive, reconstructive operations, indirect revascularization operations (1). However, to perform reconstructive surgery, a number of mandatory conditions are required, which is not always possible. With the occlusion of the main arteries of the leg, that is, in the absence of outflow paths, as well as in the absence of the ability to perform autovenous shunt operations, the possibility of reconstructive surgery is absent. Standard conservative therapy in this category of patients is also not effective. The operation of choice in this case is indirect ravascularization interventions, which include revascularizing osteotrepanation (ROT).

The bone marrow decompression operation described in the method of V.I.Zusmanovich (2) was modified by us in order to reduce the volume of surgical trauma and supplement trepanation with local stimulation of improved blood flow.

The purpose of the invention: improving arterial blood flow, microcirculation in the lower extremities by applying osteotrepanation holes in the projection of the bodies of the tibia and fibula. The result of osteotrepanation is an increase in the intensity of metabolic processes, prolonged stimulation of the microvasculature, since mechanical trauma, accompanied by damage to soft tissues and bone, leads to an increase in blood circulation. The proposed technique for stimulating aseptic inflammation by introducing talcum together with the introduction of bone marrow autodetritis stimulates microneoangiogenesis, which improves blood flow to the limb.

The method is as follows. Under general anesthesia in the patient’s position on the back, in the projection of the tibial and fibular bones, and to the condyles of the femur with an interval of 3-4 centimeters, a small diameter drill (not more than 3.5 mm) is used to apply osteotreation holes with an electric drill. Postoperative wounds are sutured tightly.

Our modification of the method of V.I.Zusmanovich was as follows:

1. Regardless of the height of the occlusion of the arterial bed, we produced trepanation holes only in the bones of the lower leg;

2. Used drills of small diameter, not more than 3.5 mm, which reduces the risk of pathological fractures.

3. The released intraosseous detritus was taken into a syringe, diluted with a 0.25% solution of novocaine to 20 ml and injected into various places of the leg muscle mass together with sterile talc.

The combined introduction of autodetritis and talc into the tissues contributed to the development of aseptic inflammation in the ischemic muscles of the leg, which ensured an improvement in blood circulation in these muscles. According to our data, in the immediate postoperative period this was due to an improvement in collateral circulation, and in the long term due to the development of new micro-extraanatomical collateral messages.

According to the proposed method, in the clinic of vascular surgery at Ryazan State Medical University named after academician I.P. Pavlov, 27 patients with OAANK IIb-III stage of the disease according to the Fonten-Pokrovsky classification were operated on. Reconstructive surgery was not possible for patients to perform.

Clinical examples.

Patient K., 62 years old, was admitted to the Department of Vascular Surgery on 02.04.02, with complaints of pain in the calf muscles of the right lower leg when walking at a distance of 150-200 meters. Diagnosis: atherosclerosis obliterans of lower limb arteries, femoral-popliteal occlusion on the right, stage IIb of the disease. On examination, the absence of pulsation on the popliteal artery (PcA), arteries of the right foot, auscultatory noise on BOTH on the right. A clear peripheral pulsation was felt on the left lower limb. During the examination: ankle-brachial index (LPI) on the right 0.63; 1.1 - on the left. Ultrasound duplex scanning (UZDS): hemodynamically insignificant stenosis of the orifice of the deep femoral artery (GBA), occlusion of the superficial femoral artery (PBA) from the orifice, collateral blood flow through the PCA, and foot arteries. The angiographic picture confirmed the data of the ultrasound scan: there was hemodynamically insignificant (~ 30%) stenosis of the mouth of the GBA. A well-developed basin of GBA with numerous collaterals and diffuse lesions of PCA, lower leg arteries. Given the data of special studies, it was decided to refrain from reconstructive operations. The patient received ROT of shin bones in our modification followed by a course of standard conservative therapy. In the immediate postoperative period without complications, there was an increase in the temperature of the skin on the operated limb. Postoperative wounds healed by first intention. On the tenth day the patient was discharged in satisfactory condition, with recommendations. After 14 months, the patient was examined in a clinic. General condition is satisfactory.

The painless distance is about 300 meters. Objectively: LPI was 0.7 on the right and 1.0 on the left. There is a clinical regression of the symptoms of arterial insufficiency.

Patient S., 58 years old, on September 5, 03, was admitted to our department complaining of pain in the calf muscles of the right lower leg when walking 300-400 meters. On examination, there was a lack of pulsation in the arteries of the foot on the right, peripheral pulsation on the left lower limb. Diagnosis: atherosclerosis obliterans of lower limb arteries, distal occlusion on the right II stage of the disease. During special examinations revealed: LPI 0.51 on the right and 1.2 on the left. Peripheral angiography revealed a diffuse change in the arteries with no hemodynamically significant stenosis of the arteries of the femoral-popliteal segment, occlusion of the tibial arteries of the right lower limb. When ultrasound scan confirmed the occlusion of the arteries of the right lower leg. Autogenous bypass grafting was not possible due to the lack of satisfactory caliber veins. Reconstructive operations cannot be performed due to the lack of a peripheral bed.

The patient received ROT of shin bones in our modification with a course of conservative measures. On the tenth day the patient was discharged in satisfactory condition. Re-examined after 6 months, LPI 0.65 on the right and 1.2 on the left, the absence of clinical progression of the AAAA was recorded.

Clinical testing of the method has shown its effectiveness in the treatment of atherosclerosis obliterans of lower limb arteries.

Information sources

1. Clinical Angiology: A Guide / Ed. A.V. Pokrovsky. In two volumes. - M .: OJSC "Publishing house" Medicine ", 2004. - 1400 p .: ill.

2. Zusmanovich V.I. USSR copyright certificate No. 1680092, class A61B 17/00, 1991 - prototype.

Claims (1)

A method of treating atherosclerosis obliterans of lower limb arteries by osteotrepanation of the bones, characterized in that the osteotrepanic holes are applied to the tibia and fibula with a small diameter drill, talcum is introduced into the muscle mass and subcutaneous tissue of the lower leg, together with taken intraosseous detritus from the tibial canal.