THE CASE OF USING INTRAOPERATIVE LOCAL THROMBOLYSIS IN THE SURGICAL TREATMENT OF CRITICAL LIMB ISCHEMIA
https://doi.org/10.25587/SVFU.2023.68.92.006
Abstract
In order to assess the safety and efficacy of intraoperative local thrombolysis followed by reconstruction and plasty of the vessel, we studied the immediate results of treatment of 28 patients with thrombotic occlusions of shunts and arteries of the lower extremities. Recently, the inflammatory theory of atherosclerosis has attracted much attention. The inflammatory process in atherosclerosis is observed from the early development of lesions in the vessel wall to the destabilization and destruction of atherosclerotic plaques. The thinning of the fibrous plug and the expansion of the lipid core in it are considered important factors of destabilization leading to damage to atherosclerosis and thrombotic occlusion. The causes leading to the development of inflammatory processes in atherosclerosis are currently studied extensively, but not exhaustively. The indication for thrombolytic therapy was severe ischemia of the lower extremities with a thrombosis duration of 3 days to 3 months and minor symptoms in the distal arterial bed. Local thrombolysis was performed using Urokinase Medak and Fortelizin, restoration of blood flow was achieved in 25 patients. Early recurrent arterial thrombosis at the site of reconstruction developed in three patients. In the long term, the operated limb was amputated in two patients.
The study showed that local intraoperative thrombolysis together with arterial reconstruction is a fairly safe and effective method for the treatment of thrombotic occlusions of the arteries of the lower extremities, shunts and prostheses at different stages of thrombus formation. This method may be a good option when selective catheter- guided thrombolysis is in doubt due to inadequate distal blood flow on angiography.
About the Authors
A. P. Sleptsov
Clinical Center, Sakha Republic (Yakutia) Hospital No. 1 – National Center of Medicine
Russian Federation
Russian Federation
SLEPTSOV Alexey Petrovich – cardiovascular surgeon, Vascular Surgery Department
677019, Yakutsk, Sergelyakhskoe shosse, 4
A. P. Semenov
Clinical Center, Sakha Republic (Yakutia) Hospital No. 1 – National Center of Medicine
Russian Federation
Russian Federation
SEMENOV Alexander Panteleimonovich – Candidate of Medical Science, doctor of cardiovascular surgery, Head of the Vascular Surgery Department
677019, Yakutsk, Sergelyakhskoe shosse, 4
P. I. Zakharov
Clinical Center, Sakha Republic (Yakutia) Hospital No. 1 – National Center of Medicine
Russian Federation
Russian Federation
ZAKHAROV Pyotr Ivanovich – Doctor of Medical Sciences, Doctor of Cardiovascular Surgery, Head of the Cardiac Surgery Department
677019, Yakutsk, Sergelyakhskoe shosse, 4
A. V. Tobokhov
M. K. Ammosov North-Eastern Federal University
Russian Federation
Russian Federation
TOBOHOV Alexander Vasilevich – Doctor of Medical Sciences, Professor, Head of the Department of Hospital Surgery and Radiation Diagnosis, Institute of Medicine
677019, Yakutsk, Sergelyakhskoe shosse, 4
V. N. Nikolaev
M. K. Ammosov North-Eastern Federal University
Russian Federation
Russian Federation
NIKOLAEV Vladimir Nikolaevich – Candidate of Medical Sciences, Associate Professor, Department of Hospital Surgery and Radiation Diagnosis, Institute of Medicine
677019, Yakutsk, Sergelyakhskoe shosse, 4
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Review
For citations:
Sleptsov A.P., Semenov A.P., Zakharov P.I., Tobokhov A.V., Nikolaev V.N. THE CASE OF USING INTRAOPERATIVE LOCAL THROMBOLYSIS IN THE SURGICAL TREATMENT OF CRITICAL LIMB ISCHEMIA. Vestnik of North-Eastern Federal University. Medical Sciences. 2023;(4):55-63. (In Russ.) https://doi.org/10.25587/SVFU.2023.68.92.006
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