A method for predicting the effectiveness of sympathectomy in ischemia of the extremities

 

(57) Abstract:

The invention relates to medicine, vascular surgery. Patients determine cutaneous blood flow in the ischemic limb using laser Doppler flowmetry. Conduct tests on the activation of impetuous and repeat the measurement. The effectiveness of the surgery are assessed by the magnitude of the reduction in skin blood flow at the height of the sample. The method allows to increase the reliability of the prediction result of the operation.

The invention relates to medicine, namely to vascular surgery, is designed to forecast the effectiveness of sympathectomy in ischemia of the extremities.

Known method of sympathectomy in ischemia of the extremities, such as obliterative arterial diseases [1, 2]. However, the known diagnostic methods do not allow high accuracy to predict the efficiency of this operation.

A known method of laser Doppler flowmetry (LDPM), allowing to assess skin blood flow [3] with the breath at the height of the maximum inspiratory (activation impetuous), which is noted for its reduction [4, 5].

The purpose of the invention is forecast sympathectomy on the reduction of skin blood flow petsa as follows.

Studies conducted at room temperature, 22-25C. On the 1st finger and the rear foot (brush) in the supine position set the probe laser Doppler flowmeter which detects the skin blood flow after its stabilization and reduction of blood flow when carrying out tests on the activation of impetuous. By reducing blood flow from 1 to 5% the effect of the operation is not checked - the prognosis is poor. By reducing the blood flow more than 5 to 15% of the forecast is questionable. By reducing blood flow more than 15% effective operation.

Example 1. Patient P., 43 years. The diagnosis of Occlusive disease of lower extremities vessels, 3 tbsp. Occlusion of artery of the left tibia. Ischemia peace.

According to the data of Doppler ultrasound, arteriography conditions for reconstructive surgery on the arteries there. The patient shows a lumbar sympathectomy. For its forecast made LDFM: blood on the 1st finger of the left foot of 1.3 ml/min per 100 g tissue, on the rear foot of 1.1 ml/min per 100 g tissue. Blood flow to the test on a breath decreased by 24% on 1 finger, 20% on the rear foot. Predictable good effect operation. Postoperative pain at rest cropped. Blood on the 1st finger of the left foot through the month rose on the intended atherosclerosis. Ischemic heart disease. The PEAKS. Angina of FC 2. Obliterating atherosclerosis of vessels of lower extremities, 3 tbsp. Stenosis of the femoral-popliteal segment to the right, the occlusion of the arteries of the right tibia. Ischemia rest. According to the ultrasonic dopplerography, aorto-arteriography because of the absence of the distal bed of the indications for reconstructive surgery on the arteries of the lower extremities no. Shown lumbar sympathectomy. For forecasting made LDFM: blood on the 1st finger of the right foot and 1.54 ml/min per 100 g tissue, on the rear foot 1.36 ml/min per 100 g tissue. The test for activation of impetuous registered a decrease of blood flow on the 1st finger of the right foot by 3% on the rear foot decrease blood flow to 2.5%. Forecast operations unfavorable. Postoperative ischemia peace was preserved, the blood flow indices remained at the same level.

Example 3. Patient S., 68 years. Diagnosis: Obliterating atherosclerosis of vessels of lower extremities, 3 tbsp. Stenosis of the femoral-popliteal segment to the left, stenosis of the arteries of the left tibia. Shown lumbar sympathectomy. For forecasting made LDFM: blood on the 1st finger of the right foot at 1.91 ml/min per 100 g tissue, on the rear foot is 1.82 ml/min per 100 g tissue. The test naigeria blood flow by 7%. Forecast operations is questionable. In the postoperative period continued chronic ischemia 3 (intermittent claudication 30 m), the blood flow indices on 1 finger through the month of 1.98 ml/min per 100 g tissue, on the rear foot 1.89 ml/min per 100 g tissue.

Thus, the method allows to predict the effectiveness of sympathectomy ischemia of the extremities.

Sources of information

1. Kohan E. P., Kohan C. E., O. Pinchuk Century Lumbar sympathectomy in the treatment of vascular diseases. - M - 1996. - 106 S.

2. Malyshev, Y. I., baking centuries, Fokin, A. A. and other Thoracic sympathectomy. Tomsk. 1982. - 90 S.

3. Burov Y. A., Mikulski E., Mikhailov, B. I. and other Possible non-invasive and intraoperative use of laser Doppler flowmetry in patients with critical ischemia of the lower extremities. /Methodology flowmetry. - Moscow, 1997. S. 81-91.

4. Kohan E. P., O. Pinchuk Century of Tissue blood flow and sympathetic reactivity with obliterating atherosclerosis of lower limb arteries. /Methodology flowmetry. - Moscow, 1997. S. 63-79.

5. Asbury, A. K., Gilliat R. U. diseases of the peripheral nervous system. M: Medicine. 1987. - 352 S.

A method for predicting the effectiveness of sympathectomy in Salerosa flowmetry to test for activation of impetuous, characterized in that the height of the sample to estimate the reduction in skin blood flow, reduced blood flow from 1 to 5% operation is not shown, decreasing blood flow from 5 to 15% forecast doubtful, while reducing blood flow more than 15% predict the efficiency of the operation.



 

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