Efficiency of combined indirect revascularization in patients with critical low extremities

Goal. Evaluation of the effectiveness of combined indirect revascularization in the treatment of critical ischemia in patients with occlusive stenotic lesions of the arteries of the foot, lower leg and thigh.
Material and methods. The analysis of the comprehensive examination and treatment of 40 patients with chronic critical ischemia of the lower extremities of stage III as a result of atherosclerotic lesions of the femoral-popliteal and ankle-foot segments was carried out. Patients according to the treatment technology were divided into 2 statistically homogeneous groups of 20 people each. Patients in the first group underwent standard lumbar sympathectomy, and patients in the second group underwent combined treatment.At the first stage, sympathectomy was performed, and at the second stage, after 2–3 months, bone marrow autologous cells were transplanted with the total volume of 48 ml from 10 points along the inner and from 10 points along the outer surface of the thigh and lower leg and from 4 points on the foot in each intertarsal space. Bone marrow cells were harvested from the ilium. The effectiveness of treatment after 7 days, 6 and 12 months was evaluated by the dynamics of the rheographic, ankle-brachial, photoplethysmographic indices, the distance of painless walking, and after 6 and 12 months - by the clinical status and quality of the life patients.
Results. In patients of the second group, compared with the first after 12 months, the arterial blood flow and microcirculation were significantly higher: rheographic index — 0.26, ankle-brachial index — 0.2, photoplethysmographic — 7.1%, painless walking distance — by 32 m. The use of combined treatment made it possible to achieve clinical status in the form of moderate and minimal improvement after 6 months in 19 (95%), and after 12 months in 18 (90%) patients, whereas after performing standard sympathectomy in 16 (80%) and in 10 (50%) patients, respectively.In the remote period, after 12 months, the limb was saved in the second group in all 20 (100%), and in the first group in 17 (85%) patients. In patients of the second group compared with the first after 12 months, a statistically significant increase in the physical component of health by 8.2% was revealed, and the mental component of health by 5.1%.
Conclusion. Combined indirect revascularization can normalize microcirculation in the ischemic limb and achieve positive dynamics of the disease.

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