Results of Revascularization Operations in Patients With Chronic Lower Limb Ischemia Caused by a Combination of Obliterating Atherosclerosis and Diabetes Mellitus

Background. Cardiovascular diseases are the leading cause of death. Obliterating atherosclerosis of the lower extremities is one of them. One of its most important risk factors is diabetes mellitus. The combination of both diseases has its own characteristics. The need for revascularization in this group of patients is beyond doubt. At the same time, glycemic and metabolic disorders, increased platelet aggregation, hypercoagulation, characteristic of patients with diabetes mellitus, lead to worse outcomes of arterial reconstructions. Objective. Analysis of the results of surgical treatment of patients with chronic lower extremity ischemia due to obliterating atherosclerosis combined with diabetes mellitus. Material and methods. A retrospective analysis of the treatment of patients with chronic lower limb ischemia due to obliterating atherosclerosis combined with diabetes mellitus was performed. These patients were treated in the Purulent and Vascular Surgery departments of the Grodno University Clinic during 2017-2024. The target group consisted of 219 patients after revascularization operations. All patients underwent examination to determine the level of occlusive-stenotic lesions of the arteries of the lower extremities. It included a physical examination, ultrasound diagnostics, classical X-ray angiography or CT angiography. In all patients the frequency of repeated revascularization interventions, high lower extremity amputations, life expectancy and the condition of the lower limb (according to the stage of chronic arterial insufficiency (CAI) according to Fontaine-Pokrovsky classification) were determined. Results. There were no intraoperative complications. In the postoperative period, 41 patients required 53 repeated surgeries. High amputation was undergone by 36 patients (32 at the level of the middle third of the thigh, 4 at the level of the middle third of the shin), which is 16.44%. During the entire observation period, 94 patients (42.92%) died, 73 of whom had their lower limbs preserved, 21 after the amputation. At the end of the study, taking into account the performance of repeated surgeries, the survival rate was 57.08% (125 patients out of 219). Preservation of the lower limb was equal to 48.86% (107 patients) including deceased patients with preserved lower limbs, 83.56% (183 patients). At the end of this study, the condition of the operated lower limbs was as follows: 3 patients (2.46%) had CAI stage 1; 45 (36.89%) had stage 2A; 40 (32.79%) had stage 2B; 10 (8.19%) had stage 3; 9 (7.38%) had stage 4 (according to the Fontaine-Pokrovsky classification), 15 patients (12.29%) had an amputation stump (1 at the level of the shin, 14 at the level of the thigh). Conclusions. Detection of obliterating atherosclerosis in patients with diabetes mellitus at the early stages of the disease significantly more often allows repeated revascularization, thereby avoiding the need for high amputation. After revascularization operations on the arteries of the lower extremities, patients with obliterating atherosclerosis combined with diabetes mellitus should be followed up once at 1 month, once at 3 months and then every 3 months during 2 years after the operation with ultrasound of the arteries of the lower extremities. In the presence of signs of stenosis of the arteries, re-thrombosis or re-occlusion at the site of primary revascularization, angiography is indicated with restoration of peripheral blood flow, without waiting for the appearance of symptoms of chronic critical limb ischemia again.